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First (Given) name: Middle name: Last (Family) name: Organization: Postal address:
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Cheque/Demand Draft details: Cheque/DD No: Name of Bank: Payments to be made in favor of Registrar, IIT Bombay payable at Mumbai. Registration form and cheque/DD to be mailed at: Mr. Abhinav Yadav, Antenna Lab, Electrical Engg. Department, IIT Bombay, Powai, Mumbai- 400076 An email confirming receipt of payment will be sent to the email-address provided above. Please bring the confirmation message with you to the registration desk to facilitate the registration process. In case of any query, please email us at email@example.com Amount: Date of Issue: