Registration Form

National Conference          On

Environmental Pollution, Restoration and Management (NCEPRM-2011)

       (Nov. 20, 2011)

Name                         …………………………………………………………

Designation              …………………………………………………………

Qualification            …………………………………………………………

Experience               …………………………………………………………

Mailing Add             …………………………………………………………

Phone                        …………………………………………………………

Mobile                       …………………………………………………………

E-mail                                    …………………………………………………………

Institution               …………………………………………………………

…………………………………………………………

Category                 Prof. / Assoc.Prof. /Asst. Prof./ Ph.D./P.G./U.G./ others

Title of the Paper   …………………………………………………………

…………………………………………………………

Interested in          Oral Presentation/Poster Presentation/Attending the Conference only

D.D. NO.                      ……………………………….           Amount           ………………

Date                            ………………………………                        Bank name     …………………………….

Date

Place                                                                                                               Signature

Note:

A.     D.D. should be drawn in favor of “Raj. Education & Research Development Society “payable at Jaipur.

B.      Photocopy of the form is acceptable.

C.      Form is also available on the Websites:    www.rerdsj.ac.in & www.cet-gov.ac.in

D.     Complete form with required endorsements should be sent to Convener, NCEPRM 2011,  Head, Chemistry, College of Engineering & Technology, Bikaner, Karni Industrial Area, Pugal Road Bikaner-334004( Raj.)  Or  Organizing Secretary, NCEPRM 2011,Raj. Education & Research Development Society, Jaipur, Third floor, Above the TVS Show Room, Dehar ka Balaji, Sikar Road, Jaipur-302023(Raj.), India.

E.      For more details contact on 9462600980, 9413389775.