Advanced Semiconductor Packaging Workshop

7th November, 2015

Indian Institute of Technology Ropar

REGISTRATION FORM

(Please read the instructions carefully before filing this form)

Name
Affiliation
Email
Mobile number
Highest academic qualification
IEEE member YES NO
If YES, your IEEE member number
Registration amount Rs. 1000 Rs. 1500 Rs. 2000 Rs.
2500
Date of transfer
Mode of bank transfer Online Offline
(Attach the pay-in slip or any other proof of payment)
Would you like to participate in the YES NO
poster session? (Only for students)

(Signature)

Important instructions:

1. Please fill all the entries. CHECK appropriate boxes, wherever applicable.
2. Registration will be incomplete without proof of payment.
3. Scan the signed form along with proof of payment and email the same to: rohit@iitrpr.ac.in
4. You will receive registration confirmation within 2 working days.
5. In case of any questions, please contact us via email/phone.

Details of Bank Transfer:

1. Account name: IEEE Student Branch, IIT Ropar

2. Account number: 34615856451
3. Name of bank: State Bank of India
4. Branch: IIT Ropar
5. IFSC code: SBIN0013181
6. Branch code: 13181