Registration form of 19thIASFC 18-19 February 2017

Left Duration for Registration

Thanks for registering with IASFC 2017

Note : Fields marked with * are mandatory.


*Title
*First name
Middle name
*Last name
Date of Birth: (DD-MM-YYYY)
- -
*Nationality
Designation
Mailing Address
*Country
*State
*City
*Oral / Poster
Title of the Presentation
*E-mail address
*Mobile Number
*Mode of Journey By Train By Bus By Plane By Self
*Arrival Date & Time
*Departure Date & Time

REGISTRATION :
Participants are requested to return Registration card enclosed with this announcement of the Congress with registration fee. Additional photocopies may be prepared, if so needed. The registration fee/membership should be remitted in favour of General Secretary, Bioved Research Society, Allahabad through DD/ E- Bankingin the A/c No. 11075979031, RTGS No-SBIN 0000006 Dr. B.K. Dwivedi, Director (BRIAT) Main Branch S.B.I. Allahabad.


MODE OF PAYMENT

(Please fill in details)

By DD drawn in favour of 'General Secretary, Bioved Research Society ' payable at Allahabad

 

 
DD No. Date Drawn on
Bank Branch

For NEFT or RTGS :
A/c Name : Dr. B.K. Dwivedi, Director (BRIAT); A/c No. 11075979031,: Bank Name : State Bank of India; Branch : Triveni , Allahabad ; IFSC Code : SBIN 0000006

NEFT No. Date