UGC Sponspored National Workshop on

Academic Writing
(Department of Management Studies, JNVU, Jodhpur)
14 -15 March, 2019
Name in Full: __________________________________________________________________

Gender: ______________________________ Mobile: ________________________________

Designation: ___________________________________________________________________

Institution: ____________________________________________________________________

Postal Address: _________________________________________________________________

______________________________________________________________________________

E-mail ID: ____________________________________________________________________

Free Accommodation Required: Yes No

Date & Time of Arrival: _________________________________________________________

Date & Time of Departure: _______________________________________________________

Registration Fee Details: Amount: __________ Mode of Payment: DD/ONLINE/CASH (Tick 1)

DD No.: ________________________________Date: _________________________________
Name of the Bank: _____________________________________________________________
(DD should be payable at Jodhpur, and in the favour of DIRECTOR NATIONAL WORKSHOP
ON ACADEMIC WRITING)
Online Transaction Details: ______________________________________________________
(Payment to be made to: Account Number: 05710100024422, Account Name: DIRECTOR
NATIONAL WORKSHOP ON ACADEMIC WRITING; IFSC Code BARB0UNIJOD; Branch:
Bank of Baroda, University Campus, Jodhpur)
*Kindly forward the scanned copies of filled form to: nationalworkshop.dmsjodhpur@gmail.com
*Payment should be made only after you receive acceptance mail
*Payment once made shall not be refunded in any case

Place : _____________________
Date : _____________________ Signature of the Participant