Registration form for Online Short Course on

Fire Modeling
(6-7 August 2020)

Name:
Education:
Designation:
Address:
Phone/Mob:
Email:
Registration fee (Rs):
#Transaction No and Date:
Registration fee: Participants from abroad USD 150; Industry/Research
Organization: Rs.5000; Academic Institute: Rs.3000.
# Payment to be made only through NEFT/RTGS in the following the account
(Confirmation will be sent only upon receiving payment and registration form).
#GST@18% will be applicable for industry/research organization.

Account Name: Conference, Seminar and Symposium IIT Roorkee

Account Number: 33136732957
IFSC Code: SBIN0001069
Bank Name: State Bank of India
Branch Name: IIT Roorkee

Signature with date,

Note: Google Form for Online Registration will be sent only to the registered
participants.