Part 1: Registration Information (please write in block capitals)


Paper NO
Name of the Participant
Affiliation
Address
 
Phone Number
E-mail
Accomodation YESNO
Part 2: Registration Payment
I would like to participate as (mark the appropriate box)
Academic Institutions/R&D IEEE/OITS/INNS/ISTE Members Student Industry
Method of Payment (mark the appropriate box)
A: Bank draft (payable at Infocity Branch Bhubaneswar in favour of NCICT 2011)
B: Bank transfer
Payment Details (A- DEMAND DRAFT)
DD Number
Date dd/mm/yyyy
Drawn on Bank
Registration Fee
Place
Payment Details (B-BANK TRANSFER)
A/C Number
Date dd/mm/yyyy
Bank Name
Registration Fee
Reference Number

#Draft Details Union Bank of India
Payable at Infocity Branch, Bhubaneswar
#Online Transfer Details Account No-595101010050056
IFSC Code-UBINO559512
Union Bank of India
Payable at Infocity Branch, Bhubaneswar
 
 

National Conference on "Future Trends in Information & Communication Technology & Application (NCICT-2011)"

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