Conference Registration (Participant)
Full Name
*
First Name
Last Name
E-mail
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Phone Number
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Affiliation
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Participant Type
*
Student / Scholar (Full Time)
Faculty / Scholar (Part Time)
Industrialist
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Wish to Attend..
Turorials
Cyber Security for Connected Healthcare
Block chain - Hype to Reality
Both
Conference Sessions
All Keynote Sessions
Tutorial Fee
Conference Attendee Fee
Total Amount (DD/NEFT)
*
Transaction ID/ DD Number
*
Transaction Date
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Month
-
Day
Year
Date
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Accommodation & Food Preference
Accommodation Needed @ College Premises ( Limited Capacity) Single Occupancy (Rs.1000/- per day) Double Occupancy (Rs.1750/- per day) Fee payment shall be done in the Hostel office.
*
Yes
No
No. of Accompanying Persons (if any)
Date of Arrival
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Month
-
Day
Year
Date
Date of Return
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Month
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Day
Year
Date
Food Preference
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