National Seminar on Current Trends in Chemistry – CtriC - 2017 Organized by

Department of Applied Chemistry, Cochin University of Science and Technology, Kochi-22, Kerala 20-21 January 2017

Registration Form Name (Prof./Dr./Ms./Mr): ………………………………………………………………… Designation: ……………………………………………………………………………….. Organization: ………………………………………………………………………………. Address: ……………………………………………………………………………………. Phone Number: ……………….……….…Email…………………………………………… I intend to:

Present Poster

Participation only

Registration Fee Amount: …………………………………………………………………. Mode of Payment of Registration Fees

* NEFT

*Demand Draft

Transaction Details (UTR/DD number): …………………………………………………..

Place: Date:

Signature

Filled/Scanned form should be sent to: Convener, CTriC-2017

Email: [email protected]

Department of Applied Chemistry

Tel- +91-9846295151

CUSAT, Kochi -22 * DD in favour of: Convener, CTriC-2017 Payable at: SBT, CUSAT Campus Branch Account Number: 67378124860 IFSC code: SBTR0000235

registration form.pdf

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