ICSC Pre-Registration Form

 

Pre-Registration form for delegates of Second International Conference for Science Communicators.

VIDNYAN BHAVAN,V.N.PURAV MARG, SION-CHUNABHATTI, MUMBAI 400022.
PHONE 91-22-5224714, 91-22-5226268, FAX 91-22-5226268 E-Mail mavipa@vsnl.com

(Please use Capital letters)

  I/We plan to attend the conference (Yes / No)
  Name in full (Individual / Institution)
  Address
  Phone nos.
  Fax nos.
  e-mail
  Web site
  Education / Profession (Individual)
  Work Area (Institution)
  Institution
  I / We intend to participate in Poster session (Yes / No)
  Tentative Title
  I / We need accommodation
  I / We have enclosed bio-data (Individual) / Work areas  (Institution) (Yes / No)

Date ____________________________         




Signature ____________________________



Rubber Stamp in case of Institution

 

 

 
N.B. -- Please do not send in your registration fees unless we inform you.