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REGISTRATION FORM Name: Dr/ Mr / Mrs / Ms________________________________________________________________ Title of the Research Paper: _____________________________________________________________ ______________________________________________________________________ _____________ Sex: (Male/Female) ___________________________________________________________________ Category :( Faculty/ Research Scholars / Students / NGO /Industry/Participant) ___________________ Organization: ______________________________________________________________________ __ Department: ______________________________________________________________________ ___ Designation: _____________________________________________________________________

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REGISTRATION FORM

Name: Dr/ Mr / Mrs / Ms________________________________________________________________

Title of the Research Paper: ________________________________________________________________________________________________________________________________________________

Sex: (Male/Female) ___________________________________________________________________

Category :( Faculty/ Research Scholars / Students / NGO /Industry/Participant) ___________________Organization: ________________________________________________________________________Department: _________________________________________________________________________Designation: _____________________________________________________________________

Correspondence Address: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Pin:_____________________________________ Phone No.:_______________________________E-mail: ______________________________________________________________________________

Mode of Presentation of Paper (Kindly Tick Options) [A]. Paper Presentation (___) [B]. PPT Presentation (___) [C].Web Conferencing / Absentia (___)

Payment Method: (Cash Deposit / NEFT/Wire Transfer/Paytm) _________________________________Payment Details:_____________________________________________________________________Issuing Bank: ___________________________________________________________________Amount & Date: __________________________________________________________________NEFT/RTGS/ Wire Transfer/Paytm Reference No.:______________________________________Scanned copy of Cash Deposit receipt attached (Yes/ No) ____________________________________Name of the Accompanying person if any:

1) ________________________________

2) ________________________________

3) ________________________________

4) ________________________________

Registration Details

Faculties/Professionals 1500₹Students/Research Scholars 1000₹Accompanying person If any 800₹Note: The authors and Co-authors both must register separately

Accommodation Accommodation Required (Yes/ No):______________________________________________________Whether paid extra for Accommodation____________________________________________________( 1000 per person/Check in Check out Noon to Noon) ₹Duration from ________________________________________________________________________Date and time of arrival_________________________________________________________________Date and time of departure______________________________________________________________Mode of Travel (Bus/ Train/Air {Kindly Mention the details})_________________________________

Bank Details Name: Jageshwar Nath singh Bank Name: ICICI Bank Bank Address: NEW CANTT. ROAD, OPP HATHIBARKALA POLICE CHOWKI, DEHRADUN Pin 248001Account No. 016401564404Account Type: Savings IFSC Code: ICIC0000164MICR Code: 248229002

PAYTM NUMBER: +91-7579006367 (Mr. Dheeraj Kumar Tiwari)

Name: ________________________Date & Place __________________

Signature