International conference on ‘Critical Public‬ Health‬ Consequences of the Double ‬Burden ‬of ‬Malnutrition and the Changing Food Environment in South and South East Asia’

The conference will be held at India International Centre, New Delhi,

from 28 to 30 March 2017

§  Deadline for submission/receiving Application Forms: 8th January, 2018
§  Please submit this form online or and mail it to:

Fields marked with * are mandatory.

Personal information
Personal name*: / Family name*:
Date of birth*: (day/month/year) / Gender*:
Place of origin
Country*: / City*:
Place of residence
Country*: / City*:
Contact information
Email*:
↑ In the field above, please indicate the email address on which you wish to receive all correspondence
Mobile: + (country code) (mobile number)
Landline: + (country code) (city code) (phone number)
Please provide at least one reliable telephone number*.
Postal address:
Professional information
Title, affiliation or profession:
Institution:
City: / Country:
Institution email: / Institution web:
Previous and current experience in Nutrition and Health sector.
Why do you want to participate in this conference
Please list your areas of particular interest relating to Nutrition, Health, both professional and activist/personal
Please describe your educational background and current occupation
Please describe your academic achievements, if any
Please list 2 contact details (email, phone) for a reference who can speak about your work
Language skills
Mother tongue*:
More languages
Include other languages in which you have some competence and rate yourself excellent, good, fair, or poor.
Language 1:
Language 2:
Language 3:
Application for scholarship assistance
o  We are committed to reducing the financial barriers to attending the conference. A limited number of scholarships for travel and registration will be available for qualified applicants.
o  Priority will be given to those with experience in nutrition, health activism and younger candidates
o  Scholarship will cover the following:
1.  Travel by Train ( upto AC III Tier)
2.  Accommodation provided by Organisers, simple twin sharing basis, for period of conference.
3.  Registration fee waiver of Rs 2,500.
o  Scholarship does not cover any other expenses of the selected candidates.
I apply for scholarship to cover my travel costs (fill YES or NO) *:
Outline the reasons for applying for scholarship (Please explain in case of selecting 'Yes')
To submit this application through email
Save this form to your computer, fill it in and email it in Word format to
(please do not convert the form into PDF or into an image format).