ICQUEST 2015 Registration Form
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Transcript of ICQUEST 2015 Registration Form
REGISTRATION FORM Name: Vaibhav Pandurang Choudhari Qualification: M.Tech (IV Sem) Designation:PG Student Paper ID: _________________________________ Track: ________________________________________ Paper Title: IEEE 802.15.4 for Intelligent Transport System ApplicationOrganization: Priyadarshini College of Engineering, NagpurAddress: Hingna T-Point Nagpur Phone/Mobile8087955809 Fax: __________________________________ E-mail ID:[email protected] Participant Category: PG Research Scholar PhD Research Scholar Non-Author Delegate Others Accommodation required: Yes/No, if yes we will provide assistance for accommodation. Registration Details: Payment Mode: Cash DD NEFT/RTGS Cash Amount: DD Details: NEFT/RTGS: DD Amount: ... Amount: DD No.: ...... Transaction ID: . Drawn Bank: ...Name of Bank: .. Dated: ....... IFSC Code: .. Dated: ................ Kindly indicate your name and Paper ID at the back of the bank Demand Draft. Signature of the Applicant: ____________________________ Date: _____________________ Place: _______________________