Registration Form

For

Five days TEQIP Workshop

on

MEMS & NEMS (Design and Fabrication)

December 15-19, 2014

Name: Gender: Male Female

Qualification:

Organization:

Designation:

Phone/Mobile No:

Email:

Address:

Do you want accommodation? Yes No

Payment details

Demand draft no:

Dated: Drawn on:

Bank transfer details:

Dated: Transaction number:

Date : Signature of the participant

Registration Fee details:

For TEQIP Universities/Institutes/ Colleges:Freeregistration

For Non-TEQIPUniversities/Institutes/Colleges:

Early Bird Registration (Till November 15, 2014):

For Students#: Rs. 8,000 (Registration) + Rs. 2,000 (accommodation*)

For Non-students: Rs. 12,000 (Registration) + Rs. 2,500 (accommodation*)

*: Hotel Accommodation on twin-sharing basis

# Limited accommodation may be available on sharing basis in IITH hostel ONLY for students, based on prior request.

Note: Registration fee include workshop kit, access to all lectures and experimental hands on sessions, lab visits, food (breakfast, lunch and dinner) for 5 days.

After Early Bird Registration (Till November 15, 2014):

For Students#: Rs. 10,000 (Registration) + Rs. 2,000 (accommodation*)

For Non-students: Rs. 15,000 (Registration) + Rs. 2,500 (accommodation*)

Important Note:

1. Seats are very limited for non-TEQIP participants. It will be on first cum first serve basis.

2. For registration, please fill this registration form and send the scanned copy to

Non-TEQIP participants can pay registration fee through

(A) Demand Draft for the requisite amount drawn in favor of Registrar, IIT Hyderabad

(B) online transfer to the following account:

Account Name: IIT Hyderabad Account No.: 30859878032 (Current A/c)

Bank Name: State Bank of India Branch: IIT - Kandi

Branch Code: 14182 IFSC Code: SBIN0014182

Note:Filled application form along with the Demand Draft has to be sent by post to the address given below. You can also mail your filled applications to along with some proof of payment.

Address:

Dr. Chandra Shekhar Sharma

Convener, MEMS & NEMS Workshop

Indian Institute of Technology (IIT), Hyderabad

Ordnance Factory Estate, Yeddumailaram- 502205, Telangana State

Email:

Phone: +91-40-2301-6112

Fax: +91-40-2301-6032