APPLICATION FORM THE 13th INDO-US CYTOMETRY WORKSHOP 8-10 th October, 2012 Indian Institute of Technology Guwahati, Assam

FAMILY/SURNAME: UPADHYAYA Registration and Tuition

Student Rs. 8,000

HRISHIKESH Faculty Non-Academic Rs. 10,000 Rs. 15,000

Highest Degree and awarding PhD, Assam University,Silchar Institution (Please attach
your C.V.)

Mail Address: E-mail: Telephone: Work: What are your research interests?

Department of Botany and Biotechnology Karimganj College, Karimganj-788710, Assam, India hkupbl_au@rediffmail.com Mobile: 9435503442 Home: Physiology, Biochemistry and Molecular Biology of Abiotic Stress in Plants

Flow Cytometer/s available in No your institution:

Accommodation required:

Yes /No:Yes. Hostel (on sharing basis, includes in course fee) or Guest House (on payment basis) .

Do you have any recent publications (if yes, please list 2-3 only):

Instructions: Please fill in the particulars, copy and paste into a word document to be emailed to: Dr Latha Rangan, Organizing Secretary, Department of Biotechnology, IIT Guwahati, lrangan@iitg.ernet.in/iucw2012@iitg.ernet.in by 15th August, 2012. If selected you will be informed by 30th August and asked to send the tuition fee by the 10th September, 2012 to reserve your place.

Signature with date