Registration Form

3rd International Conference

On
Innovative Approach in Applied Physical, Mathematical/Statistical, Chemical Sciences and Emerging
Energy Technology for Sustainable Development
(APMSCSET-2014)
Organized by
Social Welfare Foundation
In Association With
Krishi Sanskriti
On
27th 28th September, 2014
Venue:
Jawaharlal Nehru University,

New Delhi
Name: Dr/ Mr / Mrs / Ms________________________________________________________________
Title of the Research Paper:_____________________________________________________________
___________________________________________________________________________________
Sex: (Male/Female)___________________________________________________________________
Category :( Faculty/ Research Scholars / Students / NGO /Industry/Participant)___________________
Organization: ________________________________________________________________________
Department: _________________________________________________________________________
Designation: _____________________________________________________________________
Correspondence Address: ______________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Pin:_____________________________________ Phone No.:_______________________________
E-mail: ______________________________________________________________________________
Accommodation Required (Yes/ No):______________________________________________________
Duration from ________________________________________________________________________
Date and time of arrival_________________________________________________________________
Date and time of departure______________________________________________________________
If you are unable to attend the conference (Kindly mention here absentia) _________________________
Registration Fee: (Please tick)
Registration Charges:
Categories
Academic faculty/Industrial Delegates
Research Scholars
(M. Phil/Ph.D) / NGO Representative
Students(B.Tech/./M.Tech /M.Sc etc)

Indian Delegates
4000 INR

SAARC/ African
Country Delegates
150 USD

Rest of the countries

350 USD

3500 INR
2500 INR

125 USD
100 USD

250 USD
200 USD

Printing of Additional Page in Books /Journals

Listener / Accompanying Member(only Indian
Delegates)
Book/Journal & Certificate (additional copy) for
Co-Authors (if required)
Only Books/Journal (additional copy) for
Co-Authors (if required)
Only Certificates
(Co-Authors)

400 INR

15 USD

20 USD

Additional Research paper for same authors

1500 INR

**

**

700 INR

25 USD

50 USD

500 INR

15 USD

35 USD

300 INR

10 USD

20 USD

1500 INR

30 USD

50 USD

Registration Form

Payment Method: (Cash Deposit / NEFT/Wire Transfer)______________________________________

Payment Details:
Issuing Bank: ___________________________________________________________________
Amount & Date:__________________________________________________________________
NEFT/RTGS/ Wire Transfer No.:________________________________________________________
Scanned copy of Cash Deposit receipt attached (Yes/ No)____________________________________
Name of Authors/Co-authors for whom certificates is required (if paid extra for additional certificates):
1) ________________________________
2) ________________________________
3) ________________________________
4) ________________________________
5) ________________________________
6) _________________________________
Bank Details for NEFT/ Wire Transfer:
Beneficiary Name
: Social Welfare Foundation
Bank Name
: Axis Bank
Bank Address
: Plot No. 7 Block-6 & 7, Local Shopping Complex, Safdarjung Enclave, New Delhi-110029
Account No.
: 914020005983254
Account Type
: Current Account
IFSC Code
: UTIB0001358
Swift Code: AXISINBB015

Name:
Place:
Dated:

Signature:

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