Registration REGISTRATION FORM Name of Delegate : Gender : Male Female Designation : Name of Institute / Organization : Address : Email : Phone : Mobile : Whether Presenting a Paper : Yes No Paper Title : Registration Category : Regular Indian IAPR/IUPRAI Member - INR 8000 Regular Non-Indian IAPR/IUPRAI Member - USD 550 Regular Indian IAPR/IUPRAI Non Member - INR 9500 Regular Non-Indian IAPR/IUPRAI Non Member - USD 600 Student Indian IAPR/IUPRAI Member - INR 6000 Student Non-Indian IAPR/IUPRAI Member - USD 450 Student Indian IAPR/IUPRAI Non Member - INR 7000 Student Non-Indian IAPR/IUPRAI Non Member - USD 500 Only Attending Indian - INR 4000 Only Attending Non-Indian - USD 200 Mode of Payment : Online Transaction Demand Draft (DD) DD if any should be made in favour of "Registrar, IIT Roorkee" payable at State Bank of India, IIT Roorkee Branch, Roorkee, and sent to Treasurer, CVIP-2016, at the following address: Dr. Balasubramanian Raman Associate Professor Department of Computer Science and Engineering Indian Institute of Technology Roorkee Roorkee 247 667 INDIA Electronic transfer details are as follows: From Overseas: NAME OF THE BANK PUNJAB NATIONAL BANK BRANCH OFFICE INDIAN INSTITUTE OF TECHNOLOGY Roorkee, ROORKEE-247667 SWIFT Code: PUNBINBBISB ACCOUNT NAME FOREIGN CONTRIBUTION, IIT ROORKEE ACCOUNT NO 4044000100040407 BRANCH CODE 4044 From India: NAME OF THE BANK State Bank of India BRANCH OFFICE IIT Roorkee, Roorkee-247667 IFSC Code SBIN0001069 ACCOUNT NAME Conference, Seminar & Symposium, IIT Roorkee ACCOUNT NO 33136732957 BRANCH CODE 1069 Important: 1. Code no. "CONFR-12-CSE" has to be mentioned by the delegates at the time of filling form for online electronic transfer in their respective banks." 2. Proof (scan copy) of DD/online transfer should be mailed to cvip2016@iitr.ac.in Details of Payment Amount : Online Transaction ID / DD Number : Date : (Date Format DD/MM/YYYY) Bank Name : Place : IFSC/SWIFT Code : Contacts: CVIP2016 [at] iitr.ac.in
