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Registration form for One Week Workshop On TECHNOLOGY CONVERGENCE AND IT’S PRACTICES
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Name of the Participants:
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College Name:
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Residential Address:
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Email Id:
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Mobile Phone Number:
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IEEE / WIE membership Number (If want concession for)
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Payment Option: Cash/ Cheque /DD
Cheque /DD should be in the favor of “SPIT Allied Division”, payable at Mumbai
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Cheque /DD No.
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Cheque /DD Dated:
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Cheque /DD Bank Name:
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Cheque /DD Amount:
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Mode of Submission of Cheque /DD:
Gender:
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