/ Third International Conference on Recent Trends in Information, Telecommunication and Computing
ITC 2012
Aug 03-04, 2012, Bangalore, India. /

ITC 2012 - REGISTRATION FORM

(Each Paper should be registered separately by at least one author; Use X to mark any field; All fields are mandatory)

A. Personal Details
Name of the Registering Author:
Date of Birth (dd/mm/yyyy) / Gender
Total Years of Experience (Teaching & Research) / Education
Nationality
Currently residing at (Country)
Category of Registration / First Reg. / Additional Reg. / Attendee
Contact Number
Fax (Optional)
Mobile
E-mail
Note: Indian Authors residing at India, only can make payment in Indian Rupees All other Authors (including Indians currently residing at other countries) should make payment in US$
B. Official Details(only for Author/Co-Author)
Complete Affiliation (designation and department)
Name of the Institution / Organization / Country
1) Paper ID
2) Title of the Paper
3) Category
4) ACEEE Membership No: (if any)
5) Name the co-authors(if any)
6) Copyright Transferred / YES / NO
7) Camera-ready Paper Submitted / YES / NO
8) Total Number of pages* / (in digit) / (in Words)
9) Address for Communication
10) Mention other Paper IDs registering to this conference (if any)
11) Name the co-authors or Attendees/ Spouse registration (if any)
* Camera Ready paper must confirm to single column Springer LNCS Format
C. Registration Fee
Details / Indian And Economically weak countries Authors / International Authors
Registration Fees / INR. / US$
No. of additional Pages
Additional Page Charge / INR. / US$.
D. Optional Charges
Conference Accessories / Indian And Economically weak countries Authors / International Authors
1) Print Media of the Proceedings / INR. / US$
2) Additional Conf Kit with CD / INR. / US$
3) Additional Lunch / INR. / US$
4) Conference Bag / INR. / US$
5) Conference T-Shirt / INR. / US$
NOTE: If the total order of Conference Bag and Conference T-Shirt is less than 20, amount paid towards these Conference Accessories will be refunded.
E. Payment Details
1) Total money Transferred / INR. / US$.
2) Mode of payment#
3) Transaction ID
3) Bank Option ##
4) Sender Name (who actually made the transfer)
5) Bank Name and Brach Details (from where the amount is Transferred)
6) Date (dd/mm/yyyy) of payment
7) Remarks (if any)
# Mode of payment :Direct Transfer orNEFT Transfer or RTGS Transfer or Wire Transfer
## Bank Options:Axis Bank for International AuthorsorUBI Bank for Indian Authors
NOTE: Bank service charge (if any) is born by the sender. We encourage International Authors to opt Wire transfer facility and Indian Authors to NEFT or RTGS transfer. Mention your Paper ID with Conference Acronym or the Registered Author Name at the payment subject.

Declaration

I hereby declare that all the statements made in the ITC Registration Form are true to the best of my knowledge and belief. I understand and agree that, if any wrong information found in this form then this registration form may be canceled, and the paper may be removed from the conference proceedings and Springer DL without any notice.

Place:
Date: / Signature of the Registering Author
(Write the Name Above which will be considered as signature)

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