The Low-Frequency Radio Universe  (8-12 December 2008)

An event commemorating the birth centenary of Dr. Homi J. Bhabha (Oct 30, 1909 - Jan 24, 1966)
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Registration Form

Title:

           

Name on the Badge:

First Name: Last Name:     
Affiliation:

Mailing Address:

Sex :

Telephone
Email: Fax No.:
Registration:

Payment Details

This includes meals at the conference venue but not accommodation charges.

    
Credit Card Details:


Card Expiry Date:

Date of Birth:

Special requirements, if any:

I hereby authorise  to transfer the fund to TIFR current a/c no 051620100100007      

towards the Registration Fee for attending the Conference at NCRA Pune

 

Date:

 

Signature &
Name

 Please fill in the form, PRINT IT, sign it, and fax it to +91 20 2569 7257.