Sponsorship Form for National Conference on Artificial Intelligence in Health Informatics & Virtual Reality

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August 30-31, 2019
Venue - Convention Centre, Naoroji Campus
Tata Institute of Social Sciences,
Malti and Jal A. D. Naoroji Campus, Deonar Farm Road, Deonar, Mumbai – 400 088

All conference related queries can be addressed via the conference email ID- aihealthinfoconferencetiss@gmail.com

Email *

Event Sponsor's Name (Business, Organisation or Individual) *

Name of the contact person *

Phone Number *

Form of Association *

Title Sponsor - Platinum

Associate Sponsor - Golden

Co Sponsor - Silver

Payment Method *

IMPS

NEFT

RTGS

Cash

Note

Payments are to be made at:

1. Beneficiary Name - TATA INSTITUTE OF SOCIAL SCIENCES
2. Account Number - 10895954226
3. City - Mumbai
4. Bank Name - State Bank of India
5. Branch - Deonar
6. Bank MICR Code - 400002023
7. Bank IFSC Code - SBIN0003109
8. Account Type - Current

Kindly furnish the receipt or record of the payment at the reception desk on the day of the conference.

Contact
Dr M Mariappan - 9869739984
Dr. Chandan Bhasin- 8713840283
Dr. Nikhil Bhat - 9149445122
Mr Rohit Soni- 9024399637
Mr Samiran Tripathi - 9702166403

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