International Conference on

“Trends in Biochemical and Biomedical Research: Advances and Challenges”

Department of Biochemistry, Institute of Science, Banaras Hindu University Varanasi-221005, INDIA, February 13-15, 2018

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Registration Form (International Delegates)

Office Use Only: / Registration No: / Receipt No:

Name: (Dr. / Prof. /Mr. /Mrs./ Ms.)………………………………………………………………………...

(Exact name will appear on your badge and certificate)

Designation:………………………………………………………………………………………………….

Gender (Male/Female):……………………………………………………………

Specialization/Research Focus: …………………………………......

Registration category (Faculty/Post-Doctoral Fellow/Student/Industry delegate):………………………….

Presentation (Yes/No)………………………………………………………………………….

Presentation type (Invited talk/Young Scientist oral/Oral/Poster):…….…………………………………….

Organization: ………………………………………………………………………………………………...

Address: ……………………………………………………………………………………………………..

City: ……………………………..………….State ………………………………………………......

Country:……………………………………. Pin/Zip Code: ……………………………………………….

E-Mail:……………………………………...Phone number:……………………………………………….

Father’s name:…………………………….. Nationality……………………………………………………

Date of birth: ………………………………Place of birth…………………………………………………

Passport No. ……………………Date and place of issue of passport……………………………………..

Expiration date of passport………………………………………………………………………………….

Address in the passport……………………………………………………………………………………..

Name of Accompanying Person(s):………………………………………………………………......

……………………………………………………………………………………………………………….

Registration amount: ………………DD No. ……...... ………………………...Date……....……………..

Title of the presentation (Oral/ Poster), if any………………………………………………......

……………………………………………………………………………………………………………….

Signature of Head of Institute/Head of Department/Supervisor(with seal) Signature of Participant

(Only for student participants)

Note:

1.  Please send the completed form along with Registration fee remittance details to the conference secretariat.

2.  Registration confirmation will be sent by e-mail only after receiving the duly filled Registration form along with the registration fees.

3.  The official receipt of the registration will be handed over to the participants at the registration desk during the conference.

4.  Student delegates MUST submit proof and a letter signed by Head of the Institution/ Department/ Supervisor on the Institute letter head.

5.  Kindly send the DD and registration form to the conference secretariat. Please email the soft copy of the registration form to , ,

6.  For online amount transfer, please use following information:

Account Name: T B B R-2018

Account No.: 36895311704

Bank: State Bank of India

Branch: BHU Varanasi

IFSC Code: SBIN0000211

SWIFT Code: SBININBB125

Branch Code: 000211

Address: BHU, Varanasi, UP-221 005, India

7.  Please write the DD in favour of “T B B R-2018”, payable at “State Bank of India, BHU Varanasi Branch”. Payments once made, are not refundable.

8.  For accommodation please send the duly filled form to , , before November 15th 2017

Registration fee details (in USD)

Category / Early Bird (15th Nov 2017) / Regular (15th Dec 2017) / Late (15th Jan 2018) / On spot (limited)
Student / 200/- / 250/- / 300/- / 350/-
Post doctoral Fellow / 250/- / 300/- / 350/- / 400/-
Faculty / 300/- / 350/- / 400/- / 500/-
Accompanying person / 250/- / 300/- / 350/- / 400/-
Industry delegate / 400/- / 450/- / 500/- / 600/-

Registration fee includes: Participation in inaugural function and all scientific sessions of the conference, conference kit, abstract book and other educational materials, morning tea, lunch, evening tea and dinner on 13th and 14th of February 2018; morning tea and lunch on 15th of February, 2018. Any bank charges are to be borne by the depositor.

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