Pragyanam: Shah and Anchor Kutchhi Polytechnic

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SHAH AND ANCHOR KUTCHHI POLYTECHNIC

PRAGYANAM
INTERNATIONAL CONFERENCE ON RECENT
TRENDS IN COMPUTER & ELECTRONICS ENGINEERING (ICRTCEE)

Registration Form
Author Name: _______________________________________________________________________________
Surname First Name Middle Name

Co-Author Name: _______________________________________________________________________________


Surname First Name Middle Name

Co-Author Name: _______________________________________________________________________________


Surname First Name Middle Name

Co-Author Name: _______________________________________________________________________________


Surname First Name Middle Name

Co-Author Name: _______________________________________________________________________________


Surname First Name Middle Name

Paper ID: ___________________


Title of Paper: ___________________________________________________________________________________
Category (Select any one): Industry Delegate Faculty Student
No. of proceedings required: ________________ (Additional Rs.500 for each extra proceeding copy)
Presenting: Yes No

Affiliation Details:
Name: __________________________________________________________________________________________

Designation: ________________________________________ Contact No.________________________________


Address: _________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Correspondent Authors Email: ______________________________________________
Demand Draft Details Demand Draft Details(For extra proceeding)

D.D. Number:_________________ Amount:________ D.D. Number:_________________ Amount:________

Issuing Bank: ___________________________________ Issuing Bank: ___________________________________

Date: ______________ Signature: ________________ Date: ______________ Signature: ________________

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