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 *
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2. DESIGNATION *
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3. AFFILIATION/ ORGANIZATION *
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4. ADDRESS FOR CORRESPONDENCE
(Address, Street, City, State, Pincode)
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5. COUNTRY *
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6. CONTACT NUMBER (MOBILE) *
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7. E-MAIL ID *
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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
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8(A2). TITLE OF THE PAPER ONE
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8(B1). PLEASE GIVE EASY CHAIR PAPER ID FOR PAPER TWO
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8(B2). TITLE OF THE PAPER TWO
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9. IF IEEE MEMBER, PLEASE SPECIFY TYPE (MEMBER/ STUDENT MEMBER):
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10(A). REGISTRATION FEE AMOUNT *
For Registration fee details, go to http://cict2017.org/registration.php
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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) *
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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. *
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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.
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