1

Department of Chemical Engineering,

University of Petroleum and Energy Studies
Dehradun 248007
REGISTRATION FORM
DST-SERB School (organized by UPES DDN) on
Evolutionary Techniques for the Optimization of Chemical Engineering Systems
Mon 24th March Sat 29th March, 2014

Mr. MUMTAJ SHAH

Name : ...
Gender:
Male/Female
01/08/1977
Date of Birth:...
Assistant Professor
Designation:
ITM University, Gwalior
Organization:..
Address for Correspondence:..
RB-102,
Department of Chemical Engg.
.
ITM
Universe
Campus,Opposite-Sithouli Railway Station,
.
NH-75,
Jhansi
Road, Gwalior-475001, (M.P.)
..
+91-7415378332
Phone: (O) .(R)...
mumtaj.shah@gmail.com
E-Mail:
08
Experience (Years):...
Process Optimization
Research Interests:
Modeling and simulation
..
Waste water treatment
..
Knowledge of Fortran / C / Matlab (please tick)
Attach Resume/List of Publications (optional)

Degree

Year

University

B.E.

2003

RGPV, Bhopal

M.Tech

2009

HBTI, Kanpur

Payment Details
DD/Multi City Cheque No.:. Details of EFT: Dated:..
Amount: Rs. ...
Drawn on: ......
Sponsored By
Name:..
Designation:
Organization:..
I agree to bring my laptop when I come to attend this DST-SERB School
Signature (Applicant)
Recommended

Signature
(Head of the Institution, with Seal)