REGISTRATION FORM

(To be filled in Block Letters and mailed/e-mailed/faxed before 15 July, 2001 to Dr. K. J. Ahmad, Organizing Secretary, ICPEP-2, Rana Pratap Marg, National Botanical Research Institute, Lucknow-226001, India)

 

 

Photograph

 

 
 

 

 

 

DELEGATE (Please type or print in BLOCK LETTERS)

 

 

SURNAME*                                      FIRST NAME                                    MIDDLE NAME

 

Title                   Prof.               Dr.                Ms.                Mrs.                Mr.

Affiliation__________________________________________________________________

Institution__________________________________________________________________

Mailing address: ____________________________________________________________                 

__________________________________________________________________________

__________________________________________________________________________

Phone:____________________________________________________________________

Fax:______________________________________________________________________

E-mail:____________________________________________________________________

Details of Passport:___________________________________________________________

Abstract title  _______________________________________________________________

 

Accompanying person(s)*:

Surname                 First name              Middle name

(i)  

(ii)                            

 

[FrontPage Save Results Component]

  I am submitting the abstract and will attend the Conference.  

I will not present any paper but would attend the Conference.  

I need hostel accommodation.  

I need hotel accommodation through Travel Agent.  

I am paying the Registration fee (10% discount)

               Amount__________   Draft No.____________  Date___________  

I will pay full Registration fee later or on arrival.  

 

Date                                                                                                                 Signature

__________________________________________________________________________________

Conference authorised Travel Agent  (SITA WORLD TRAVEL (I) LIMITED) may be contacted for hotel/ air/train reservations, transport and tourism facilities or any other assistance.

*All delegates and accompanying persons are requested to affix a passport size photograph.