Registration Form

Print this page and tick in the appropriate box
Mail this form to the address given below before 22 nd  January

 To
Prof. T R Rama Mohan
Hon. General Secretary  , PMAI
Department of Metallurgical Engineering and Material Science
Indian Institute of Technology , Bombay
Powai , Mumbai   4000076

Phone   (o)    022 - 576 7643  ,  Fax : 022 578 3480
Phone (Res)   022 - 576 8643  , 579 2088

email : mttrria@met.iitb.ernet.in

Please tick in the appropriate box

[  ]    I will attend the seminar and give a technical presentation on the topic _________________

___________________________________

[  ]    I am sending a technical profile of the company .

[  ]    I will attend the seminar but not give a technical presentation . I am sending a technical profile

of  the company .
.
[  ]    I cannot attend the seminar . I am sending a technical profile of the company .

[  ]    I / We would like to Sponser / Co Sponser the seminar . The names of the Three / Two

delegates and the technical write up is enclosed .

[  ]    I / We would like to book Out Side Cover Page / Inside Cover Page / Full Page / Half

Page Advertisement  in the souvenir .

[  ]    I / We would like to exhibit our products in a Stall / Display and / or distribute pamphlets

using a  table space .

A  Demand Draft  / Crossed Cheque  No _______________ Dated ____________  For

______________ drawn in favour of  CONVENER , NATIONAL  SEMINAR PM - 99  is

enclosed towards  Sponsership / Co Sponsership / Full Stall in Exhibition / Table Space /

Advertisement in Souvenir / Registration  .
 

NAME :

DESIGNATION :

POSTAL ADDRESS :
 
 
 
 

TELEPHONE: (OFF)                                  (RES.)
 

FAX                                                             EMAIL
 

SIGNATURE & DATE
 

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