ICIC 2011

September 2-3, 2011

Department of Instrumentation and Control Systems Engineering
PSG College of Technology
Coimbatore - 641004, Tamilnadu, India

REGISTRATION FORM
Name

: ......

Designation

: ......

Organisation

: ..

Address

: ..
..
..

Telephone

: ..

Fax

: ..

E-mail

: ..

A banker's cheque / Demand draft in favour of Organizing Secretary,

ICIC'11 payable at Coimbatore.

DD. No. ........ Dated ................... for sum of

Rs(In words ...........)

Date :

Signature

1. The Registration form to reach the Organising Secretary on or before

August 6, 2011.
2. Additional copies may be photocopied or downloaded from
www.psgtech.edu.