ICITEM
CITEM REGISTRATION FORM
INTERNATIONAL CONFERENCE
ENCE ON INNOVATIVE TRENDS IN ENGINEERING
G AND MANAGEMENT
www.icitem.com
icitem.com
icitem.help@gmail.com/ papers.icitem @gmail.com
All questions/inquiries concerning registration and payment should be addressed to above Mail ID only
Payment of a registration fee covers the Conference Proceedings with ISBN (e- Cofy / Print Copy),, Publication and Participation Certificates
publication in Journals.
Name of the Conference/
Event/Seminar/Meeting
Date of the Conference/
Venue/Place of the Conference/ Event/Seminar/Meeting
(DD/MM/YYYY)
Event/Seminar/Meeting
PLEASE KINDLY FILL IN A SEPARATE REGISTRATION FORM FOR EACH CONFERENCE PARTICIPANT
Authors Full Name Highest
(Prof./Dr./Mr./Mrs.) Qualification
Affiliation/Designation Nationality
Mailing Address Age
Passport
City, Zip, Country
Number:
Mobile number/
Whatsapp number Email Id
(With Country code)
Paper ID:
ACCEPTED PAPER (Provided in the acceptance letter)
INFORMATION
Title of the research paper:
Guided by:
Mail ID:
Co-Authors Name &
1. 2. 3. Contact No:
Designation
Affiliation:
FUND TRANSFER/PAYMENT INFORMATION
MODE OF FUND TRANSFER
(Online link using credit card or debt AMOUNT DEPOSITED
card/PayPal/ (in INR/USD only)
Bank deposit/
Western Union transfer)
DATE OF FUND TRANSFER
(DD/MM/YYYY) Order ID/Traction ID/Ref. ID
ICITEM
ADDITIONAL INFORMATION IT IS MANDATORY TO FILL ALL
Will you present Conference Proceedings Print copy____________________(Y/N). INFORMATION IN ENGLISH ONLY AND
No. of Persons in the paper with you?(Including your Co
Co-authors)______. SEND A SCAN/PHOTO COPY TO
T
Will your Guide/HOD/Principal Participate in the Event?_________(Y/N). papers.icitem
citem@gmail.com
Total years of Experience (if any Academic and Industry)_______
Industry)___________________.
Declaration & Undertaking
1. I have not published this paper anywhere before and I am transferring the Copyright of my paper to ICITEM
2. I will not cause or involve in any sort of violence or disturbance within and Outside of the Conference/Event Venue or during
the travel to the venue at any Country during my Visa Period.
3. ICITEM has all rights reserved to shift the venue, rescheduling
cheduling the date of the Event any time.
4. I do here by declare that all the information given by me is true and if at any moment it is found to be wrong my registr
registration Paste Photo Here
for event will be cancelled by ICITEM and take necessary action against me. (The
he photo should match your Govt.
5. I have read all the rules and regulations at http://icitem.com/dosdonts/ and agreed. Issued ID/ Passport)
6. ICITEM Management has all rights reserved to publish this paper at any journal in future and has all rights reserved to Mandatory
publish my photo of form the conference in the website.
7. ICITEM is not responsible for any violation of Rules and Regulations by me or by my Co-authors of this paper at any country
during the Event.
Note: It is mandatory to provide a scan copy of Govt. Issued ID Proof / Passport along with this Registration form
Signature (Author):_____________________________________________ ____________________
Date (DD/MM/YYYY)______
