1st International Conference on Business Analytics and Intelligence Registration form

Name (in official records): Prof. Prasad Kulkarni

PARTICIPANTS DETAILS

Designation: Assistant professor

Address for Communication: MBA department, Gogte Institute of Technology, Udyambag, Belgaum - 590006 Phone: Mobile: 09902474810 Emails:pvkulkarni@git.edu

Emergency Contact #: 08904213695

Organisation Name: Gogte Institute of Technology, ,

ORGANISATION DETAILS

Organisation Address: Udyambag, Belgaum

Phone: 0831-24985000

Fax:

E-mail:

hodmba@git.edu

SPONSOR DETAILS

Name:

Dr. A. S. Deshpande

Designation: Principal Official Address: Gogte Institute of Technology, Udyambag, Belgaum- 590006 Phone: 0831-24985000 Fax: E-mail: principal@git.edu

JOINING INFORMATION

DD drawn on bank:

Karnataka Bank

bearing No:

Favoring Indian Institute of Management Bangalore towards programme fee for Rs.3000

Fee Receipt in the name of,

Organisation

Self

Date:

11/11/2013

Signature of the Participant

Signature of the Sponsoring Authority

Duly completed nomination form/s may please be sent to: Data Center and Analytics Lab, Indian Institute of Management Bangalore, Bannerghatta Road, Bangalore- 560 076 Ph: +91-80-26993822 Email : baiconf2013@iimb.ernet.in Website : http://dcal.iimb.ernet.in/baiconf2013