REGISTRATION FORM 1.
Name : ………………………………………………………………… ………………………………………………………. (M/F)
2. Designation : …………………………………………………………... 3. Institute/University : …………………………………………………… …………………………………………………………………………. 4. Address : ……………………………………………………………….. ………………………………………………………………… 5. Phone : ……………………………………………………………….(O) ……………………………………………………………….(R) …………………………………………………………..(Mobile) 6. Title of the Paper : ………………………………………………………. …………………………………………………………………………… 7. Mode of Presentation : Oral/Poster
8. Arrival : …………………………… Departure : ……………………….
9. Registration Fees : ………………………………………………………. DD No :………………………………………………………………….. (A DD Rs. 500.00 to be made in favour of Convener, Shanti Swaroop Bhatnagar Awardees Conference, DEVI AHILYA UNIVERSITY, Indore)
Signature
For Detail Please Contact Convener: Dr. Brijesh Kumar School of Physics Devi Ahilya Vishwavidyalaya, Khandwa Road, Indore Tel: 0731-2467028 (O) 0731-2446801 (R) 09425352516 (M) email:
[email protected]
