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IITER Listener Registration Form-New

This document is a registration form for an event that covers payment details, participant details, and a declaration. It requests information such as name, affiliation, payment method, and includes a declaration agreeing to the event terms.

Uploaded by

Prietenul Tau
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
31 views

IITER Listener Registration Form-New

This document is a registration form for an event that covers payment details, participant details, and a declaration. It requests information such as name, affiliation, payment method, and includes a declaration agreeing to the event terms.

Uploaded by

Prietenul Tau
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REGISTRATION FORM e-mail: info@iiter.

org
web: http://iiter.org

Payment of a registration fee covers the cost to attend all conference activities, coffee breaks, conference reception and banquet, and
all lunches during the conference. In addition, each registrant will receive a copy of the conference proceedings with ISBN. Notice
that this registration fee does not cover transportation fee, accommodation fee, and after conference tour fee.

All questions and inquiries concerning registration Please complete this form and email a scanned copy to:
and payment should be addressed to: [email protected]
[email protected]

Event Name
Venue/Place of Event
Date of Event

PLEASE KINDLY FILL IN A SEPARATE REGISTRATION FORM FOR EACH CONFERENCE PARTICIPANT
Highest
Full Name
Qualification
Affiliation/Designation

Mailing Address

City, Zip, Country Passport Number:

Mobile (With Country code) Email

PAYMENT INFORMATION

Total Amount (USD) Bank Name Remitter Date Ref. No

For online transfer Order ID/Traction ID:


(Debt card/Credit card/Online Banking)

Note: It is mandatory to provide a scan copy of ID Proof /Passport along with this Registration form

ADDITIONAL INFORMATION

 Will you present physically at the event____________________________(Y/N).

 No. of Persons attending the event with you?(Including your Co-authors)______.

 Will your Guide/HOD/Principal attending will attend the Event?_________(Y/N).

Declaration & Undertaking Photo Here


(the photo should match your
1. I will not cause or involve in any sort of violence or disturbance within and Outside of the Conference/Event Passport)
Venue or during the travel to the venue at any Country during my Visa Period.
2. IITER has all rights reserved to shift the venue, rescheduling the date of the Event.
3. I do here by declare that all the information given by me is true and if at any moment it is found to be wrong
my registration for event will be cancelled by IITER and take necessary action against me.
4. IITER is not responsible for any violation of Rules and Regulations by me or by my Co-authors of this paper at
any country during the Event.

Signature (Listener): ____________ Date:



Remarks: ___________

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