Registration

    Accompanied with spouse
Name 1.
Name 2.
Name 3. 
Name 4.  
Affiliation  
Mailing Address  
Town / City  
Country  
Telephone  
Fax
Email  
 We wish to Participate & Contribute through :
     
   
 
Title of Paper  
Name of Author  
 Accommodation Request
 Hotel
Category
Type
Arrival Date (dd / mm / yyyy)  
Departure Date (dd / mm / yyyy)  
 Payment Details
Demand Draft / Cheque No.  
Date (dd / mm / yyyy)  
for Rs/US $  
 drawn in favour of AITISM-12 payable at Ranchi is enclosed for following :