Indian Institute of Technology (Indian School of Mines), Dhanbad

Department of Computer Science and Engineering

Dhanbad, Jharkhand, India - 826004, www.iitism.ac.in

Two-Week FDP on Sensor Networks and IoTs

(Sponsored by ICPS Division of DST, Govt. of India)
(20-29 June 2019)

Registration Form
1. Name of the Participant:

2. Designation:
Photo
3. Department:

4. Gender: Female Male

5. Name of the Institute:

6. Address of the Institute:

7. E-Mail ID:

8. Contact Number:

9. Highest Degree: PhD M. Tech B.Tech Others

10. Accommodation : Required Not Required

Instructions: The Number of participants is strictly restricted to 30. Shortlisted candidates will be informed on 31.05.2019.

Signature of Participant with Date

It is certified that ............................................................................... Institute has no objection for imparting the

Two-week FDP on Sensor Networks and IoT at Indian Institute of Technology (ISM), Dhanbad during the period
of the above named candidate. The particulars as furnished in the aforesaid para are found correct as per the
records available in this Institution.

Signature of Head of the Institute with Seal

Note: Send the duly Filled form along with the Institute/Company Identity Card and higher degree certificate to
Prof. Tarachand Amgoth, Assistant Professor, Department of Computer Sciecne and Engineering, Indian Institute
of Technology (Indian School of Mines), Dhanbad, Jharkhand, 826004 and a scan copy to tarachand@iitism.ac.in

Contact For any Queries: tarachand@iitism.ac.in/acsrao@iitism.ac.in Phone: +91 9471191420/14

LAST DATE: 5.30 PM, 30.05.2019