INDIAN INSTITUTE OF TECHNOLOGY INDORE
Consent and Information for Attending the Convocation
Wish to attend the convocation (Yes or No) ?
If Yes, please provide details of accompanying guests (Otherwise fill NA )
Name (in capital letters)
Your answer
Roll No.
Your answer
Academic Program
Discipline
Your answer
Email
Your answer
Mobile No.
Your answer
Correspondence Address
Your answer
City
Your answer
State
Your answer
Pin code
Your answer
Time and date of arrival to Indore
MM
/
DD
/
YYYY
Time
:
Time and date of departure from Indore
MM
/
DD
/
YYYY
Time
:
Photograph (Passport size in Google drive photo link, size maximum 50 kb and 600 dpi)
Your answer
Details of the Accompanying Guests
Number of guests accompanying the graduating student:
(Maximum two guests are allowed per graduating student)
Your answer
Details of accompanying guest
1. Name
Your answer
Mobile
Your answer
E-Mail-id
Your answer
Relationship
Your answer
Age
Your answer
Time and date of arrival to Indore
MM
/
DD
/
YYYY
Time
:
Time and date of departure from Indore
MM
/
DD
/
YYYY
Time
:
Photograph (Passport size in Google drive photo link, size maximum 50 kb and 600 dpi)
Your answer
2. Name
Your answer
Mobile
Your answer
E-mail-id
Your answer
Relationship
Your answer
Age
Your answer
Time and date of arrival to Indore
MM
/
DD
/
YYYY
Time
:
Time and date of departure from Indore
MM
/
DD
/
YYYY
Time
:
Photograph (Passport size in Google drive photo link, size maximum 50 kb and 600 dpi)
Your answer
If not attending the convocation, please provide address for sending your Degree by post (Otherwise fill NA)
Address for sending Degree
Your answer
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