Annexure-A

13thUttarakhandState Science & Technology Congress 2018-19

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(page 1 of 4)

1- REGISTRATION INFORMATION

Presenting Author *

Date of Birth: ______

Gender: M/ F : _____

Name:______

E-mail: ______(Acceptance letter will be sent on this email only)*

Mobile No: ______

Category:

Category 1[Y/N] :

(date of birth falls on or after 02-02-1989i.e. age upto 30 years on 01-02-2019)

or

Category 2[Y/N] :

(date of birth falls between 02-02-1979 and 01-02-1989 i.e. age above 30 but less than or upto 40 years on 01-02-2019)

or

Category 3[Y/N] :

(date of birth falls on or before 01-02-1979 i.e. age above 40 years on 01-02-2019)

or

Category 4[Y/N] :

(no age bar for Innovator category)

Already awarded with Young Scientist Award:[Y/N] ______Year: ______

(The author once awarded (under category 1 or 2); will not be considered again for Young Scientist Award)

Already awarded with Innovator of the Year Award: [Y/N] ______Year: ______

(The author once awarded (under category 4); will not be considered again for Innovator of the year Award)

Presentation Type: [Oral/Poster] (any one): ______

Discipline: (choose from the “List of Disciplines#1”): ______

(e.g. Agricultural Sciences, Biotechnology, Biochemistry and Microbiology, Botany, Chemistry…. etc.)

Designation/ Position: ______

(e.g. JRF, M.Pharm Student, M.Tech Student, Ph.D Scholar, Assistant Professor, Research Scholar…. …. etc.)

Registration fee: Rs NIL / 1000/ 2000 : ______

(choose from the “Registration Fee #2”)

Bank: ______DD No:______:DD Date: ______

Accommodation Required: Y/N : ____ (for non-local participants only)

2-ABSTRACT DETAILS

Title of the Paper (in CAPITAL letters):______

Author’s name and organizational/institutional address (including Presenting Author):

(Including presenting author)

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2-

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Abstract: (Totalnumber of Words*: ______ (in digit))

(Abstract length- Minimum: 200 words, Maximum: 500 words)

(Abstract should not contain any figure or table)

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3- CERTIFICATE

(must be issued by any Organization/ Institution from Uttarakhand only)

Concerned Head/HOD/ P.I./Guide/Supervisor is requested to ensure that each item on the Certificate is filled-out completely and accurately.

don’t paste scanned signature and seal

No changes should be done in the prescribed format

  1. This is certified that ……………………………….……(name of the presenting author) is workingas ………………………… …………….…………(position) at ……………………………………………… …………………………………………………………...…(organization/ institutioncomplete address).
  2. He/She is employed/pursuing research/studentin the organization.
  3. He/She is with/ without financial support/ fellowship/ salary/ emolument/ remuneration etc. in the organization.
  4. He/She has passed his/her

PG degree in ………………………….. (science only) (copy of PG Degree must be enclosed)

or

Bachelor degree in ……………………………………. (Engineering/ Medical Sciences/ Ayurveda/ Veterinary Sciences). (copy of Degree must be enclosed)

  1. He/ She has been allowed to present research paper entitled …………………..……………….…… …………………… ………….……… under Category-1/2/3 or 4 for Oral/Poster presentation, under ……………………….. ………… ………………………………..… discipline(List of Disciplines #1).
  2. His/ Her date of birth is ……………… (date of birth certificatemust be enclosed).
  3. This is also verified that (a)- research area and the research work belongs to Uttarakhand and (b)- the presenting author resides in Uttarakhand.
  4. He/She has ‘Received’/ ‘Not Received’ the Young Scientist/ Innovator of the Year Award during previous USSTC.

CHECK LIST*

Copy of Date of birth certificate:  [Y/ N]

Copy of PG degree in Science:  [Y/ N] OR Copy of Bachelor degree in (Engineering/ Medical Sciences/

Ayurveda/ Veterinary Sciences):  [Y/ N]

Signature

Name of Institutional Head/ HOD/ P.I./Guide/Supervisor

Designation, Address, Seal

Name and Signatureof Presenting Author

Date: ______

* Mandatory

#1 - List of Disciplines:
Code Discipline / Code Discipline
  1. Agricultural Sciences
/
  1. Biotechnology, Biochemistry and Microbiology

  1. Botany
/
  1. Chemistry

  1. Earth Sciences including Geology, Geophysics and Geography
/
  1. Engineering Science and Technology

  1. Environmental Science and Forestry
/
  1. Home Science

  1. Material Science and Nano Technology
/
  1. Mathematics; Statistics and Computer Science

  1. Medical Science and Pharmaceutical Science
/
  1. Physics

  1. Rural Technology
/
  1. Science & Society/ Science Communication

  1. Veterinary Sciences and Animal Husbandry
/
  1. Zoology

#2 - Registration Fee
Detail / Fee (in INR)
1- Research Scholars/ Students (without fellowship) / Nil
2- Research Scholars (with fellowship) / Rs 1,000/- (Rs One Thousand only)
3- Others / Rs 2,000/- (Rs Two Thousand only)