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Registration Form: Job Title

This document is a registration form for an event with information on registration fees, payment options, and deadlines. It requests the registrant's contact information and includes fields for name, address, job title, gender, phone numbers, and email. Registration fees vary based on student, scholar, or industrial status, and include or exclude accommodation. Payment can be made via e-banking, demand draft, or multicity cheque. The last dates for abstract submission, full paper submission, and fee payment are provided. Accommodation booking and arrival/departure dates are also requested. Faculty contacts are listed at the bottom for additional information.

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Cvm Gupta
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45 views1 page

Registration Form: Job Title

This document is a registration form for an event with information on registration fees, payment options, and deadlines. It requests the registrant's contact information and includes fields for name, address, job title, gender, phone numbers, and email. Registration fees vary based on student, scholar, or industrial status, and include or exclude accommodation. Payment can be made via e-banking, demand draft, or multicity cheque. The last dates for abstract submission, full paper submission, and fee payment are provided. Accommodation booking and arrival/departure dates are also requested. Faculty contacts are listed at the bottom for additional information.

Uploaded by

Cvm Gupta
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
Download as ppt, pdf, or txt
Download as ppt, pdf, or txt
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REGISTRATION FORM

Name : _______________________________
Address : ____________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Job Title :____________________________________

Gender :
Male
Female
Phone:______________ Fax:_____________
Mobile :_______________________________
E-mail :_______________________________
______________________________________
REGISTRATION FEE ( without accommodation)
Students - Rs.500
Research Scholar - Rs.700
Institute Delegates-Rs. 1500
Industrial Delegates-Rs.2000
Spouse (Not For Students) - Rs1000

Are you submitting Research/Poster Papers :


Yes
No
Research
Poster
Title of Paper :
(i) Research Paper_____________________
_________________________________
(ii) Poster Paper_______________________
_________________________________
Do you want the organizers to book your
accommodation ?
Yes
No
If yes then: Arrival Date & Time:___________
Departure Date &Time:________
REGISTRATION FEE(with accommodation)
Students - Rs. 1000
Research Scholar - Rs.1500
Institute Delegates-Rs. 2500
Industrial Delegates-Rs.3000
Spouse (Not For Students) - Rs1500

Modes of Payment
E-banking : In the name of ABEFT a/c no. 1460307474,Central Bank Of India, Branch HBTI, Kanpur .
Demand Draft: Should be drawn in favour of ABEFT, payable at Kanpur.
Multicity Cheque (A/C Payee) should be drawn in favour of ABEFT a/c no. 1460307474.
Payment Details
Name and branch of the Bank :____________________________________________________________________
D.D. No/cheque/payment no.. :______________________

Date :__________ Amount :______________

GENERAL INFORMATION
Last date for receipt of abstract : 20.02.2013.
Last date for submission of full paper: 23.02.2013.
last date for registration fee payment: 25.02.2013.
Registration includes registration kit ,food & local hospitality for two days .
Faculty adviser
Alak Kumar Singh and Lalit kumar Singh
BIOCHEMICAL ENGG. & FOOD TECH. DEPTT.
HARCOURT BUTLER TECHNOLOGICAL INSTITUTE, KANPUR (U.P.)- 208002
Phone No. (O) 0512-2534001-5 extension 139; FAX NO: 0512-2533812
EMAIL: genesis2013abeft@gmail.comWEB: www.abefthbti.org, www.hbti.ac.in/genesis2k13

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