Registration Form

Name: Dr/ Mr / Mrs / Ms________________________________________________________________

Title of the Research Paper: _____________________________________________________________

___________________________________________________________________________________

Sex: (Male/Female) ___________________________________________________________________

Category :( Faculty/ Research Scholars / Students / NGO /Industry/Participant) ___________________

Organization: ________________________________________________________________________
Department: _________________________________________________________________________
Designation: _____________________________________________________________________

Correspondence Address: ______________________________________________________________

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Pin:_____________________________________ Phone No.:_______________________________
E-mail: ______________________________________________________________________________

Mode of Presentation of Paper (Kindly Tick Options)

[A]. Paper Presentation (___) [B]. Absentia (___)

Payment Method: (Cash Deposit / NEFT/Wire Transfer/) _________________________________
Issuing Bank: ___________________________________________________________________
Amount & Date: __________________________________________________________________
NEFT/RTGS/ Wire Transfer/Paytm Reference No.:______________________________________
Scanned copy of Cash Deposit receipt attached (Yes/ No) ____________________________________

Name of the Accompanying person if any:

1) ________________________________

2) ________________________________

3) ________________________________

4) ________________________________

Registration Details

Faculties/Professionals/Students/Research Scholars from

other Institutions/ University ₹800
   
Faculties/Professionals/Students/Research Scholars from ₹500
Banaras Hindu University
Co-author from any other Institution/University ₹300
   
Co-author from Banaras Hindu University ₹300
 
Presentation of Paper in absentia ₹800
 

Note: The authors and Co-authors both must register separately

In case, of paper in absentia the author and coauthor both must register separately.
 
Bank Details
Bank Name : State Bank of India
Account Number : 37377115782
Account Name : Prof HariharNathTripathi Foundation
Account Type : Current
IFSC Code : SBIN0000211

Name: ________________________
Date & Place __________________
Signature