Registration Form for the Workshop on
Applied Stochastic Models and Optimization (ASMO-2017)
26-27 May, 2017 Venue: Department of Mathematics, Indian Institute of Technology Rookee, Uttarakhand Name: ____________________ _________________________ __________________________ Sex: M /F __________________ _______________________ __ Age:______________________ Organization:_______________ _________________________ __________________________ Position/ Designation: _______ _________________________ ___________________________ Mailing Address: ___________ _________________________ __________________________ __________________________ _________________________ __________________________ Telephone:______________________ Mob. ________________ Email: ____________________ Whether accommodation required?: Yes/No ______________ __________________________ Accompanying persons (if any, with name(s) & relationship):_ ______________________________ Travel schedule: Arrival: ____________________Departure: _______________________________ Whether interested in paper/poster presentation?:
Yes/No
Title of paper/poster to be presented in the Workshop:
Payment Details (Please include charges for each accompanying person @Rs 500.00): DD Details (DD in favor of “Mathematical Colloquium” payable at “Roorkee”): Amount: ___________________ Date: ____________________ Bank on which drawn: _______ _________________________
Place: Date:
Signature:………………………………….
Note: Please e-mail the copy of filled registration form to
[email protected]. The registration fee will be submitted at the venue during 1.30-2.30 PM on 26 May 2017.
