The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

QIP Short-Term Course: Engineering Applications of Modern Inorganic Chemistry (1-5 November 2018) (Last Date Extended till 22 October 2018)
21 responses
Loading...
Loading responses…
Date f Birth:
No responses yet for this question.
Title
Copy chart
No responses yet for this question.
Name
Copy chart
No responses yet for this question.
Designation
Copy chart
No responses yet for this question.
Name of Department
Copy chart
No responses yet for this question.
Name of College/Institute/University/Organisation
Copy chart
No responses yet for this question.
E-mail
Copy chart
No responses yet for this question.
Mobile No(s)
Copy chart
No responses yet for this question.
Accommodation Required
Copy chart
No responses yet for this question.
Arrival Date
No responses yet for this question.
Departure Date
No responses yet for this question.
Catagory
Copy chart
No responses yet for this question.
Payment Mode
Copy chart
No responses yet for this question.
Online Bank Transfer Details (Beneficiary: Name: Coordinator, Continuing Education Programme, Account Number: 10426004713, Name of Bank: State Bank of India, Branch: IIT Kanpur, Kanpur 208016, IFSC/RTGS/NEFT Code: SBIN0001161, MICR Code: 2080002041)
Copy chart
No responses yet for this question.
Cheque/DD No.
Copy chart
No responses yet for this question.
Chq./DD-Date of Issue
No responses yet for this question.
How this course will be relevant/useful to you? (At least 50 words)
No responses yet for this question.
Research Expertise/Interest
Copy chart
No responses yet for this question.
Any Other Comments/Request
No responses yet for this question.
Take Approval from
Copy chart
No responses yet for this question.
Your Signature, Date, Place
Copy chart
No responses yet for this question.
Signature & Approval from Sponsoring Authority With Seal, Place & Date
Copy chart
No responses yet for this question.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

.