* Required
Category (Please tick one):
Local students (other than presenter): Rs. 1000Professional (other than presenter): Rs. 1500Local Paper presenters (Early Bird Registration: till 03-10-2018): Rs 2000Local Paper presenters (Late Registration from 04-10-2018): Rs 3000Local Paper presenters On Desk Registration Fee: Rs. 3000
Title (Prof./Dr./Mr./ Ms.)*:
Name:*
Designation:*
Institution:*
Contact Details
Complete Postal Address:*
City:*
Country:*
Telephone Number:*
Fax Number:
Mobile Number:
Email Address:*
For Paper Presenters Only
Paper Id:
Paper Title:
Payment Mode (Please provide details) to be paid in account number: Habib Bank: 00427991603303
Account Receipt Number/Bank Draft Number/Pay Order Number:*
Cash paid Rs.
received by (name with signature)
Date of payment:
Upload scanned copy of receipt/challan/pay order:* (jpeg, png, gif, bmp)
Note: Your registration will be confirmed on receiving the full registration fee with a copy of payment receipt. All registered participants will receive certificates of attendance/presentation in the ICITL 2018.
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