REGISTRATION FORM [Send PDF copy of this FORM by mail to amm2016nitk@gmail DO NOT SEND BY POST] National Institute of Technology Karnataka, Surathkal Srinivasnagar, Mangalore 575025, Indi: QIP-II Sponsored Three-d dvanced Mat National Workshop on als and 28-30" September 2016 Name (in Block letters): SRIKUMAR BIRADAR Designation /Highest Qualification: Ph.D. Research Scholar Department: Mechanical Engineering Institute Name: National Institute of Technology Karnataka, Surathkal PIN: 575025 Mobile:9964824617 Email: srikumar biradar@gmail.com Experience-Teaching/Industry/Research: 4/2/NIL Accommodation required? NO DECLARATION BY THE PARTICIPANT ‘The information furnished above is true to the best of my knowledge. I agree to abide by the rules and regulations governing the programme. If selected, I shall attend the programme for the entire duration. Lalso undertake the responsibility to inform the Coordinator sufficiently in advance, in case Tam unable to attend the programme. Date: 15-09-2016 Signttter of Applicant SPONSORSHIP CERTIFIC. Certified that Mr SRIKUMAR BIRADAR is an Research Scholar of our institute and is hereby permitted to attend the Three-day National Workshop on “Advanced Materials and Manufacturing selected. Signature of the Restatch Guide (With seal) Place: Surathkal Date: 15-09-2016