REGISTRATION

FORM

A Five-Day SERC School on
NONLINEAR PROGRAMMING AND SOFT COMPUTING TECHNIQUES
FOR CHEMICAL ENGINEERING
December 12-16, 2011
Venue: Chemical Engineering Department, NIT Durgapur

NAME:_______________________________________GENDER: M/F

AGE: _____ Yrs

DESIGNATION:_____________________________________________________
ORGANIZATION:____________________________________________________
_____________________________________________________________________

MAILING ADDRESS:__________________________________________________
______________________________________________________________________
_______________________________________________________________________

TELEPHONE:____________________ FAX:_____________________________
e-mail:__________________________
QUALIFICATION (highest
degree):_____________________________Discipline:_____________________
EXPERIENCE: _______ Yrs
BROAD AREA OF WORK/RESEARCH
EXPERIENCE:___________________________________________

COURSE FEE PAYMENT: DD No.______________Dt.:_________________Rs.:______________
Signature of
Applicant:_____________________________________Date:__________________________
Recommended by (Name &
Designation):__________________________________________________________________
Head of Institute/Organization______________________________________Date:_____________