PKI Outreach Programme (POP

)

ONE-DAY SYMPOSIUM REGISTRATION FORM
PKI Outreach Programme
Please print and return by e-mail, regular mail or fax.

Date:

19 August 2010

Time:

09:00 A.M. to 05:00 P.M

Venue:

Hotel Abad Plaza, Cochin

Information of Participant
Name:________________________________________________________________
Gender:  Male  Female
Designation: ___________________________________________________________
Organisation:___________________________________________________________
Address:_______________________________________________________________
City:________________________________ Postal code:________________________
Telephone:_____________________________Mobile:__________________________
Fax:_____________________________ E-mail:_______________________________

Registration Fee & Payment details
Fee includes admission to Symposium sessions, lunch, Symposium Kit.
Symposium fee

: Rs 500/- per participant

No registration fee is payable for the nominations from Government Departments
Mode of Payment:
Rs_______________

 Cash

 Cheque: No________

 Demand Draft: No_________

Cheque / Demand Draft should be in favour of “CDAC”, payable at Bangalore (Only local Cheques

will be accepted)
Date: ____/____/_________

Signature:______________________________

CENTRE FOR DEVELOPMENT OF ADVANCED COMPUTING
#68, Electronics City, Bangalore - 560100
Tel: 080 28523300; Fax: 080 28522590; e-mail: pop@ncb.ernet.in
Website: http://www.cdacbangalore.in

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