(Open for all interested persons)

    1.      Name in Full: (Write your name the way you want it on the Certificate)

    2.   Member of IEEE: YES/NO

    3.     Address for Correspondence:

             Phone No:  

             Mobile No:

               E Mail ID:

    4.      Accommodation needed:  YES/NO

          (Accommodation  is Free for students)

    5.      Fee: Rs. ________paid by CASH /DD

DD No.______________, Date_________

in Favour of National Institute of Science and Technology, Berhampur.

6.      Signature of the Participant:

      Fees for Registration:

     Member: Rs.100/-

    Non Member: Rs.150/-

         Application may be submitted by filling up the Registration Form to Coordinator  IEEE Workshop, National Institute of Science and Technology, Palur Hills, Berhampur,       761 008, Orissa along with the bankdraft in favour of “National Institute of Science and Technology, Berhampur”.

     Contact Numbers:

     Coordinator, IEEE Workshop

     (0680) 2492421, 2492422, 9937183859, (0680) 2403144 (Res.), 9437166619

      FAX: 0680 2492 627,

      Email: ieeenist@yahoo.com