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Short Term Course On Characterization Techniques For Multifunctional Materials Registration Form

This document is a registration form for a short term course on characterization techniques for multifunctional materials being held from June 28-30, 2013 at the National Institute of Technology in Rourkela, India. The form requests the applicant's contact information, educational background, experience, accommodation preferences if staying on campus, and payment details to register for the course by June 7, 2013. It provides contact information for the two course coordinators.

Uploaded by

Bhabani Sankar Swain
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85 views1 page

Short Term Course On Characterization Techniques For Multifunctional Materials Registration Form

This document is a registration form for a short term course on characterization techniques for multifunctional materials being held from June 28-30, 2013 at the National Institute of Technology in Rourkela, India. The form requests the applicant's contact information, educational background, experience, accommodation preferences if staying on campus, and payment details to register for the course by June 7, 2013. It provides contact information for the two course coordinators.

Uploaded by

Bhabani Sankar Swain
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Short Term Course on

CHARACTERIZATION TECHNIQUES FOR MULTIFUNCTIONAL MATERIALS


JUNE 28 - 30, 2013

Registration Form
1. Name: ....................
2. Designation: ...........
3. Organization: .........
4. Mailing Address: ..........
................................
5. Contact No.: ... Fax: ...
6. Email: ................
7. Educational Qualification: ......
8. Experience: ............
9. Accommodation in Campus: YES / NO. If yes, select the appropriate from below,
(i) Accommodation: Hostel / Guest house

(ii) Gender: Male / Female

10. Registration Fee Details:


Amount: Rs DD No: .....
Drawn on.Branch...

Signature of Applicant:________________
Please send the filled in form to the either conveners on or before June 7, 2013
Coordinators
1. Prof. Dillip K.Pradhan, Department of Physics, National Institute of Technology, Rourkela,
Odisha-769008, (INDIA)
2. Prof. P.N.Vishwakarma, Department of Physics, National Institute of Technology, Rourkela,
Odisha-769008 (INDIA)

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