Application Form for Registration
Electronics & ICT Academy, IIT Roorkee
Email address *
Pattern Recognition and Image Analysis
25th May to 29th May 2018
Note
Draft will be made in the name of "DEAN SRIC IIT ROORKEE"
Name of the Applicant *
Gender *
Required
Father's Name *
Category *
Date of Birth (MM/DD/YYYY) *
MM
/
DD
/
YYYY
Name & Address of the Organization/Institute
Organization/Institute/College Name *
Address *
City *
District *
State/UT *
Qualification *
Branch *
Required
Designation *
Required
Mobile Number *
Do You Need Accomodation *
Required
Demand Draft/RTGS/NEFT Details *
Amount *
Demand Draft/RTGS/NEFT Number *
Payment Date *
MM
/
DD
/
YYYY
Name of The Bank *
Applicant Photograph *
Required
Scan copy of payment receipt *
Required
Note
1. The Demand Draft with application form must reach to the following address: Mr. Prateek Sharma, EICT Academy, ECE Department, IIT Roorkee, Uttarakhand 247667.
A copy of your responses will be emailed to the address you provided.
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