Two Day Intensive Workshop On Embedded Systems - IEEE Gujarat ...

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25 Νοε 2013 (πριν από 3 χρόνια και 8 μήνες)

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National
Workshop on Cyber Security 2013

Dhirubhai Ambani Institute of Information and Communication Technology

Gandhinagar, Gujarat.


16
-
17
November
, 20
13



Registration Form


Important notes o
n Registration:



Seats are limited





Early
bird
registration
is valid only when
this form with the appropriate payment is received
at
the
mailing address (given below)

by

N
ovember
6
, 2013
.



Payment must be made through Demand Draft

drawn in favor of

IEEE
Gujarat Section


payable at
Ahmedabad
.



If you are availing the discounted rate offered to IEEE/CSI/GESIA members
or to students
then you
need to produce your membership card

or institute ID card

at the registration desk on
16 Nov 2013
.



You can also register online at
http://ieeegujaratsection.org/cyber
-
security
-
2013/online_registration/



***
After receiving your form by post we will confirm your registration on the email ID provided by you
.


Registration details (Please fill in all Capital Letters)

Title:

First Name:

Last Name:

Gender:


Female


Male

Affiliation:

Designation:


Stude
nt


Professional

I am member of:


IEEE


CSI


GESIA

Membership No.:

Address:



City:

State:

PIN:

Contact no
:

Fax:

E Mail
***
:


Workshop

Registration fees

Registration Fees

Early Bird Registration

(till
Nov 6
)

On the Spot Registration (Nov 16
)

Professionals

(IEEE/CSI/GESIA members)

Rs 24
00

Rs 3000

Professionals (
Non
-
M
embers)

Rs
2800

Rs
3500

Students
(IEEE/CSI/GESIA members)

Rs
1200

Rs
1500

Students (Non
-
Members)

Rs
1600

Rs
2000


Payment

Details

Demand Draft

in favor of
IEEE
Gujarat Section

payable at
Ahmedabad

Number

Amount

Name of the Issuing Bank

Dated (dd/mm/yyy)













Date

Signature of the Participant

Mail this form along with the payment at the following address:


Ms. Deepa Poduval

Faculty Block
-

2

DA
-
IICT

Near I
ndroda Circle

Gandhinagar


382007, Gujarat

For Office Use:


R
eceived Date: / /2013

Received Amount: Rs

Receiving Authority
Signature