The Shirpur Education Society’s

R. C. Patel Institute of Technology, Shirpur Nimzari Naka, Shirpur (M.S.) 425405 Department of Electronics and Telecommunication Engineering

A. I. C. T. E. Sponsored Two Day Workshop on ‘Scilab & its Applications’. Affix here

REGISTRATION FORM

passport size colour photograph

1. Name of Participant:_________________________________________________________ 2. Designation:_________________________________________________________________ 3. Department:_________________________________________________________________ 4. Institute:____________________________________________________________________ 5. Whether Institute is approved by AICTE? __________________________________ 6. Mailing Address:_____________________________________________________________ ______________________________________________________________________________ 7. E-mail id:____________________________________________________________________ 8. Mobile Number: ___________________________________ Fax:_____________________ 9. Educational Qualification:___________________________________________________ 10. Experience:_________________________________________________________________

Place:__________________________ Signature of Applicant:________________________

Office Seal

Signature of Director/ Principal/ HOD