4th Conference on Excellence in Research & Education 2012

10th 13th May, 2012

Venue: Indian Institute of Management Indore

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Registration Form
1. Name : ____________________________________________________________________
2. Date of Birth (dd/mm/yyyy) : ____________________________ Sex : M

3. Present status :
Doctoral student*

Corporate*

Post Graduate Student*

Self employed

Faculty*

Other**

*Organization / Institute name : _________________________________________________

**Others, please specify _________________________________________________________
4. Address for correspondence:
___________________________________________________________________________
___________________________________________________________________________
____________________________________________________ PIN : _________________
Phone : _______________________________ Fax : _______________________________
Email id : ____________________________ Mobile : ____________________________
5. Area of research paper :
Economics

Operations Management

Financial Management

Information System

Marketing Management

Corporate Governance

Human Resource

Quantitative Methods

Strategic Management

Social Issues

Business Communication

Others*

*Others, please specify __________________________________________________________

6. Registration Fee (non-refundable):

Rs. 3000 (non-corporate participants) / Rs. 5000 (corporate participants)
Additional Rs. 5000 (if family accommodation is required)
Payment Details: DD No : ____________________ Date (dd/mm/yyyy): _____________
Name of the Bank : ____________________ Amount (Rs.) : ________

Signature : __________________________

Date (dd/mm/yyyy) : ___________________

Note:
1. Payment should be made by Demand Draft only in favor of Indian Institute of Management,
Indore, payable at Indore.
2. All communications related to the conference would be entertained by email only
(cere12@iimidr.ac.in or f11subhashis@iimidr.ac.in)
3. Please mention your name, phone number, area of research paper, correspondence address, and
institute / organization name at the back of the demand draft.
4. Registration fee is non-refundable in all circumstances.

Please send the completed registration form to:

Subhashis Sinha (FPM)
Coordinator, Conference on Excellence in Research and Education 2012,
Indian Institute of Management, Indore
Prabandh Shikhar, Rau-Pithampur Road, Indore 453331
Madhya Pradesh, India
Email : cere12@iimidr.ac.in / f11subhashis@iimidr.ac.in
Mobile : +91 8964812619
Tel : +91 731 2439666
Fax : +91 731 2439800