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Reg Form

This document is a registration form for a short-term course on intelligent system applications for smart electric grid solutions being held from November 15-19, 2010 at IIT Kanpur in India. It requests the applicant's name, date of birth, designation, organization, contact details, educational background, experience, payment details, and recommendation from their institution if applicable.

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jayeshjoglekar
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96 views1 page

Reg Form

This document is a registration form for a short-term course on intelligent system applications for smart electric grid solutions being held from November 15-19, 2010 at IIT Kanpur in India. It requests the applicant's name, date of birth, designation, organization, contact details, educational background, experience, payment details, and recommendation from their institution if applicable.

Uploaded by

jayeshjoglekar
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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REGISTRATION FORM

Short-Term Course On
Intelligent System Applications to the Smart Electric Grid Solutions
November 15-19, 2010

Name _________________________________________________________________________

Date of birth ___________________ Designation _____________________________________

Organization ___________________________________________________________________

Address for _______________________________________________________________


correspondence _______________________________________________________________
_______________________________________________________________
Phone _______________________________ Fax ______________________________________
Email ________________________________________

Degree Year University

Experience __________Years _________ Months


Nature of experience _______________________________________________________

Payment details:
Draft No. __________________Date: _____________ Issuing bank _______________________
Amount _____________________ Drawn on _________________________________________
(In favour of “Continuing Education Program, IIT Kanpur” payable at SBI, IIT Kanpur (11161)

Signature of applicant
For the participants from academic institution only:
Will you be interested to be considered for the non-QIP candidate, if not selected in QIP category,
with reduced course registration fee? YES/NO
_____________________________________________

Sponsored by (for academic institutions):


Name _________________________Designation __________________________________
Organization ________________________________________________________________

Recommended.

Signature (Head of Institution/Organization with Seal)

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