International Conference on Environmental Challenges

A Global Concern
October 15-16, 2010
Organised by: Kanya Maha Vidyalaya, Jalandhar
Delegate Registration Form
1. Title (Ms./Mrs./Mr.): ……………

2. Name of the Participant: ……………………………………………

3. Designation: ………………………….

4. Institution/Organization: …………………………………………….

5. Postal Address:
……………………………………………………………………………………….
………………………………………………………………………………………………………………
………………….

6. Telephone/ Mobile no: …………………

7. E-Mail: …………………………………..

8. Accompanying Person(s): ……………….

9. Title of the research paper to be presented (If any):

……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

10. Accommodation required? (Yes/No): ………..

If Yes, specify dates: From ……………….. To ……..……………..

(The accommodation to the participants will be arranged in hotels. Only students will be provided
free accommodation in hostels. For further details please write to organizing secretary or Co-
organizing secretary at kmvevs@yahoo.co.in)

11. Registration Details:

Demand Draft No.:………………..

(In favour of Principal, Kanya Maha Vidyalaya, Jalandhar, India)
Date: …………………….
Drawn on: ………………………………
Amount: ……………………………….

Date: ………………
Place: ……………… Signature of the delegate