GITAM UNIVERSITY

(ESTD. U/S 3 OF THE UGC ACT, 1956)

GITAM INSTITUTE OF MANAGEMENT

NATIONAL SEMINAR
on

OPPORTUNITIES IN RURAL MARKETING

21ST & 22ND FEBRUARY 2014
Registration Form
Participant Details
1. Name :
___________________________________________________
___________________________________________________
2. Designation:

_____________________________________________

3. Institution/
Organization
4. Adress for
Communication

_____________________________________________
______________________________________
______________________________________
______________________________________
______________________________________

5. Phone : _______________________ Fax :

6. E-mail:

____________________

___________________________________________________

7. Registration Fee particulars:

Amount / DD. No. / Bank : ____________________________________
______________________________________
______________________________________
(D.D. in favour of the Seminars & Workshops Account - GIM, payable
at Visakhapatnam)
Registration Fee :
Corporate Participants
For Students/Scholars

Rs. 2000/Rs. 500/-

For Academicians
In Absentia

Rs.1000/Rs. 2000/-

Date:
Place:

Signature

Mailing Address :

Dr. R. Venu Gopal, Conference Co- Convenor

GITAM INSTITUTE OF MANAGEMENT, GITAM University, Rushikonda, Visakhapatnam.
Ph: 91 98498 10375 Fax: 0891-2790037 E-mail: marketing.gim@gitam.in
www.gitam.edu