Registration Form – International Conference - Adwitya 2016 1. Registration Details Please note: If more than one person from an organisation or institution wishes to register, each individual is requested to complete a separate form. Miss

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Title Family Name Given Name Organisation/Department/Inst itute Position Address ZIP Code and City Country Telephone (country code + access code) E-Mail Fax (country code + access code)

2. Visa Assistance (please skip this portion if you DO NOT require a visa to INDIA) Please contact immediately the Indian consulate or embassy in your country to receive information on how to apply for a visa to India. If you require a visa, you are requested to fill in the information request below and send in your registration form to the organisers by not later than 18th September 2016. Please note that a visa application process may take as long as two months. The organisers will provide you with a formal invitation letter to facilitate your Visa application process, as soon as you have registered and paid the conference fee. Please note that in most cases you will need a valid passport of not less than six (6) months. 1

Information Request for the purpose of Visa application Name as seen in the passport Passport number Place of Issue Birthdate and Birthplace

3. If you require assistance in accommodation please fill in the accommodation form and send it to us at the earliest.

2

Registration Form - IIHMR Bangalore

Registration Form – International Conference - Adwitya 2016. 1. ... If more than one person from an organisation or institution wishes to register, ... Family Name.

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