Registration Form

Registration Form

 

National Conference on

Sustainable Chemistry: Challenges and Opportunities”

January 9-10, 2012.

(This form may be photocopied)

 

                        Name:------------------------------------------------------------------------------------------------

                        Designation:------------------------------------------------------------------------------------------

                        Address:---------------------------------------------------------------------------------------------

                        ------------------------------------------------------------------------------------------------------

                        E-mail:-----------------------------------------------------------------------------------------------

                        Fax No.:----------------------Phone:-----------------------(O)--------------(R)--------------------

                        Date of Arrival & Time:------------------------------------------------------------------------------

                        Date of Departure & Time:---------------------------------------------------------------------------

                        Hotel accommodation needed?: ---- Yes/No--------------------------------------------

                        Mode of Registration fees: DD/Cheque/Cash---------------------------------------------------

                        Paper Presentation:   ---- Oral/Poster ---------------------------------------------------

                        Any other: -------------------------------------------------------------------------------------------

                        ------------------------------------------------------------------------------------------------------

 

                                                                                                                            Signature

 

                        Please send the dully filled registration form to Dr. M.K. Patil (Organizing Secretary) before

                        20th Dec., 2011 via post or e-mail (mkpatil05@gmail.com & ncscco2012@gmail.com).

 

 

Address for correspondence

Dr. M.K. Patil (Organizing Secretary)

Department of Chemistry,

Dr. Babasaheb Ambedkar Marathwada University,

Sub-campus Osmanabad 413 501 (M.S.)
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meghshyam patil,
Nov 6, 2011, 5:06 AM
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