Indian Institute Of Technology, Gandhinagar :  Workshop on Fire Safety
March 2-3, 2013,  IIT Gandhinagar, Ahmedabad
Sign in to Google to save your progress. Learn more
Name *
Designation *
Organization *
Mailing Address
Phone
Office
Phone
Home
Mobile No: *
Email 1: *
Email 2
Qualification and Background *
Registration Fee:
Registration Fee details:

1. For Professional : Rs. 12000/-
2. For Faculty: Rs. 8000/-
3. For Students: Rs: 6000/-

Please check on the following option in the form below:

1. Demand Draft payable to:

'Workshop on Fire Safety'

Name of Branch:IIT Gandhinagar Branch
Name of Bank:State Bank of India
IFSC Code: SBIN0011770

Mail the draft to:
Chinmay Ghoroi, Ph.D
Assistant Professor, Chemical Engineering Department
Indian Institute of Technology Gandhinagar (Office : S3/204)
VGEC Campus, Chandkheda, Ahmedabad, Gujarat - 382424
Tel: +91-79-32459897 • Fax : 91-79-23972586
Email: safety@iitgn.ac.in
Web: www.iitgn.ac.in/safety
 
Give details of payment in the form below including - Draft No., Date of issue, Amount


Mode of payment - (read the information above) *
Clear selection
Registration Fee : Give the details of payment (read the information above) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of IIT Gandhinagar.