CSA 2012 - REGISTRATION FORM

(Each Paper should be registered separately by at least one author; Use X to mark any field)

A. Personal Details
Name of the Registering Author:
Date of Birth (dd/mm/yyyy) / Gender
Total Years of Experience (Teaching & Research) / Education
Nationality
Currently residing at (Country)
Category of Registration / First Reg. / Additional Reg. / Attendee
Contact Number
Fax (Optional)
Mobile
E-mail
B. Official Details(only for Author/Co-Author)
Complete Affiliation (designation and department)
Name of the Institution / Organization / Country
1) Paper ID
2) Title of the Paper
3) Category
4) ACEEE Membership No: (if any)
5) Name the co-authors(if any)
6) Copyright Transferred / YES / NO
7) Camera-ready Paper Submitted / YES / NO
8) Total Number of pages* / (in digit) / (in Words)
9) Address for Communication(print media to be dispatched – if ordered)
10) Mention other Paper IDs registering to this conference (if any)
11) Name the co-authors or Attendees/ Spouse registration (if any)
* Camera Ready paper must confirm to double column ACEEE Format
C. Registration Fee
Details / Economically weak countryAuthors / International Authors
Registration Fees
No. of additional Pages
Additional Page Charge
D. Optional Charges
Conference Accessories / Economically weak country Authors / International Authors
1). Print Media of the Proceedings
2) Additional Conf Kit with CD
3) Additional Lunch
4). Conference Bag
5). Conference T-Shirt
NOTE: If the total order of Conference Bag and Conference T-Shirt is less than 20, amount paid towards these Conference Accessories will be refunded.
E. Payment Details
1) Total money Transferred
2) Mode of payment#
3) Transaction ID
3) Bank Option ##
4) Sender Name (who actually made the transfer)
5) Bank Name and Brach Details (from where the amount is Transferred)
6) Date (dd/mm/yyyy) of payment
7) Remarks (if any)
# Mode of payment :RTGS Transfer or Wire Transfer
## Bank Options:ING Bank orAxis Bank
NOTE: Bank service charge (if any) is born by the sender. Mention your Paper ID with Conference Acronym or the Registered Author Name at the payment subject.

Declaration

I hereby declare that all the statements made in the Registration Form are true to the best of my knowledge and belief.

Place:
Date: / Signature of the Registering Author
(Write the Name Above which will be considered as signature)

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