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Registration Form

This registration form is for the Energy Conclave 2010 Workshop on "Civilian Nuclear Energy" being held on January 9, 2010 at the Indian Institute of Technology Kanpur. The form requests the participant's name, designation, organization, gender, contact information, qualifications, experience, and category. It must be signed by the participant and countersigned if the participant is a student. Completed forms should be sent to the listed address at IIT Kanpur by the specified date.

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111 views1 page

Registration Form

This registration form is for the Energy Conclave 2010 Workshop on "Civilian Nuclear Energy" being held on January 9, 2010 at the Indian Institute of Technology Kanpur. The form requests the participant's name, designation, organization, gender, contact information, qualifications, experience, and category. It must be signed by the participant and countersigned if the participant is a student. Completed forms should be sent to the listed address at IIT Kanpur by the specified date.

Uploaded by

asifanis
Copyright
© Attribution Non-Commercial (BY-NC)
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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Indian Institute of Technology Kanpur

REGISTRATION FORM

Energy Conclave 2010


Workshop
On
“Civilian Nuclear Energy”
January 9, 2010
Name: _______________________________________________

Designation: __________________________________________ Paste Your


Recent
Organisation: __________________________________________ Photograph

Gender (for accommodation*): _M / F_

Correspondence Address: __________________________________________________

_________________________________________________ PIN:__________________

Phone: ____________________ Fax: ___________________E-mail:________________

Qualification:____________________ Experience:_______________________________

Category
□ Student □ Academic Institution
□ Industry / Regulatory Institutions / R&D Organisations

(Signature of Participant)
Note: Students should get the form countersigned from the head of the institution/
Department
Please send this form to
Divyadristi Prayogshala
Nuclear Engineering and technology Programme
Indian Institute of Technology Kanpur
Kanpur (UP) 208016 India

*Applicant has to pay the charges

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