CICT-2017 REGISTRATION FORM
CONFERENCE ON INFORMATION AND COMMUNICATION TECHNOLOGY - 2017
NOVEMBER 3-5, 2017 // ABV-IIITM Gwalior
(Jointly organized by ABV-IIITM Gwalior, IIIT Allahabad, PDPM IIITDM Jabalpur, and IIITDM Kancheepuram)
1. NAME OF DELEGATE
Your answer
2. DESIGNATION
Your answer
3. AFFILIATION/ ORGANIZATION
Your answer
4. ADDRESS FOR CORRESPONDENCE
(Address, Street, City, State, Pincode)
Your answer
5. COUNTRY
Your answer
6. CONTACT NUMBER (MOBILE)
Your answer
7. E-MAIL ID
Your answer
8. ARE YOU AN AUTHOR/PRESENTER
Note: With single registration of author, at the most two papers of respective author may be registered/presented. If the number of papers are more than two then register separately.
8(A1). IF YES, PLEASE GIVE EASY CHAIR PAPER ID FOR PAPER ONE
Your answer
8(A2). TITLE OF THE PAPER ONE
Your answer
8(B1). PLEASE GIVE EASY CHAIR PAPER ID FOR PAPER TWO
Your answer
8(B2). TITLE OF THE PAPER TWO
Your answer
9. IF IEEE MEMBER, PLEASE SPECIFY TYPE (MEMBER/ STUDENT MEMBER):
Your answer
10(A). REGISTRATION FEE AMOUNT
For Registration fee details, go to http://cict2017.org/registration.php
Your answer
10(B). WHETHER ACCOMMODATION IS REQUIRED?
For Accommodation details, go to http://cict2017.org/travel.php
IF YES, PLEASE SELECT
10(C). TUTORIAL FEES - INR 500/- only (IF ATTENDING):
CICT -2017 is inviting good number of quality speakers for both keynote speeches and tutorials.
11. TOTAL AMOUNT PAID (10A + 10B + 10C)
Your answer
MODE OF PAYMENT:
For Payment details, go to http://cict2017.org/registration.php
12(A). SELECT ONE OF THE PAYMENT MODE
12(B). PLEASE, PROVIDE TRANSACTION ID/ REFERENCE NO./ DD NO.
Your answer
IMPORTANT NOTE:-
1. Kindly, e-mail the proof of payment (scan copy) to cict2017.gwl@gmail.com.
2. Upon completion of registration, you will receive a confirmation email from us in a few days as a proof of your registration.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms