Statistical Techniques in Biological and Medical Sciences

STBMS-2016

June 13-18, 2016

APPLICATION FORM

1. Submit duly filled application form (Page: 1-3)through email onlyto the workshop co-ordinators at:>

2. For early consideration of your application, send registration fee details (scanned copy of DDor transaction ID)through an email.

3. Selected participants will be intimated through email/phone.

PERSONAL INFORMATION

First Name
(Dr./ Prof. /Mr./Ms.)
Last Name
Designation/ Department/Institute
Contact Number: / Office (with STD Code) / Mobile
Address: / Line 1:
Line2:
State:
Zip Code:
Email:
Gender: Male / Female
Educational Qualification
Degree/ Specialization / College/University / Year of Passing / Subject(s)
Bachelor
Master
Doctorate
Diploma
Specialization
Any Other Information

Place: ______SIGNATURE:

Date: ______

Details of payment (Please give the following details)
Participants / Registration Fee / Electronic Transfer/Demand Draft/Multicity Cheque or Payable at par Cheque
Details
Early Bird
(Up TO MaY 15, 2016) / May 16 TO MaY 31, 2016
Students (UG/PG) / 2000/- / 2500/- / Electronic Transfer
Ph.D.Fellows/Research Associates / 3000/- / 3500/- / Bank / Panjab National Bank, THE MALL, SHIMLA (H.P)
Faculty / 4000/- / 4500/- / Beneficiary / Jaypee University of Information Technology, Waknaghat
Industry/others / 7000/- / 7500/- / Account No. / 0427002100682105
Note:
  • Registration will be based upon the thirst area of candidate.
  • Priority criterion will be first come first serve.
  • Participant may avail lodging and boarding facility for the whole workshop at Rs. 2000/- for Faculty/Industry candidate. For Students and Research Fellows it is 1000/- For each candidate.
  • Group participants from same institution can avail additional discount in registration of Rs. 500/- each participant.
  • Fill the registration fee details, i.e, draft number or transaction ID in case online transaction and email scanned copy of draft.
  • In case of registration fee through Demand Draft/Multicity Cheque or Payable at par Cheque along with duly completed registration form should be sentONLY BYINDIAN SPEED POSTto:
    Dr. Narendra Kumar,
    Assistant Professor,
Jaypee University of Information Technology,
P.O. Waknaghat, Teh. Kandaghat
District Solan-173234,Himachal Pradesh, INDIA

Phone: (01792) 239400/ 239385 / IFSC Code / PUNB0042700
ACCOUNT TYPE / Current
Transaction ID:
Demand Draft/Multicity Cheque or Payable at par Cheque
Group Registration for persons: / In case of group registration submit all applications through a single e-mail.
Name of Group Applicants
Accommodation facility (Yes/No)
Arrival Date:
Departure Date:
DD AMOUNT: RS.
In Favour of / Jaypee University of Information Technology, Waknaghat
DD NUMBER:
NEFT ID:
DATE:
BANK and Branch Details:
Registration fee will be non-refundable.

Place: ______SIGNATURE:

Date: ______

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