REGISTRATION FORM Savitribai Phule Pune University, IEEE ComSoc Pune Chapter & IETE Pune Centre Technically Sponsored

One Week

Short Term Training Program (STTP) on

“Design, Testing, Performance Evaluation & Applications of Microwave Antennae 2016” 21st to 26th November 2016 Full Name : _______________________________________________________ Designation : ______________________________________________________ Affiliation & Address : _______________________________________________ _________________________________________________________________ _________________________________________________________________ Phone (O) :________________________

(R): __________________________

E-mail : __________________________________________________________ .

Amount ` : .......................................

IEEE / IETE Membership No.: __________________ (if applicable) Payment mode : DD / Online (please tick) Please find enclosed Demand Draft

D. D. No.: __________________________

Bank _________________________ Branch: ___________________________ Drawn in favour of “VIIT, Pune”, payable at “Pune”. Transaction Reference No. ____________________ (online payment) Accommodation Required : YES / NO (From ....../11/2016 to ....... /11/2016)

Date : Place :

Seal & Signature of Sponsor

Signature of Participant

registration form -

Applications of Microwave Antennae 2016”. Savitribai Phule Pune University,. IEEE ComSoc Pune Chapter & IETE Pune Centre Technically Sponsored st th.

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