Registration Form Frontiers of Research

on Speech & Music (FRSM - 2019)

Name:
Mr/Mrs/Ms/Dr./Prof. ________________________________________________________________
Designation: ___________________________________________________________________________
Name of Institution: __________________________________________________________________
Sex: Male/Female
Address: _______________________________________________________________________________
__________________________________________________________________________________________
E-mail: _________________________________________________________________________________
Telephone: ____________________________________________________________________________
I want to attend the symposium……………………………………………………………………….….. Yes / No

I want to present a paper in the symposium………………………………………………………….. Yes / No

I would attend as delegate (Student / Faculty Member / Industry Person)

I am enclosing a DD/NEFT of Rs. ______________

DD/ NEFT No. and Date: _______________________

(Please send a scanned copy of the Draft/ NEFT via email to frsm2019@allenhouse.ac.in

I want an accommodation:
Yes Institute Hostel (Free)
Yes Outside (Paid – approx. Rs. 1000/day)
No To be arrange by self
(If ‘Yes’, send separate request as stated earlier in the “Accommodation” section)

Signature______________________________

To,
Prof. A K Dutta
Chairman, Organizing Committee (FRSM-2019)
Sir C.V. Raman Center for Physics & Music
Jadavpur University, Kolkata – 700032
Ph. : (033) 2457-2862
E-mail : frsm2019@allenhouse.ac.in; convener_frsm2019@allenhouse.ac.in