Team ID .

Autonomous Robotics Workshop Registration

Workshop Date: 26-27 Dec 11

Venue: Sri Shakthi Institute of Engineering and Technology, Coimbatore

Team Leader Name: ____________________________________________

Branch & Year: ________________ Contact No.: _____________________
College: ______________________________________________________
Email id: ______________________________________________________
Member 2 Name: ______________________________________________
Branch & Year: ________________ Contact No.: _____________________
College: ______________________________________________________
Email id: ______________________________________________________
Member 3 Name: ______________________________________________
Branch & Year: ________________ Contact No.: _____________________
College: ______________________________________________________
Email id: ______________________________________________________
Member 4 Name: ______________________________________________
Branch & Year: ________________ Contact No.: _____________________
College: ______________________________________________________
Email id: ______________________________________________________

Payment Received By

Team Leader Signature