Short Term Course on

CHARACTERIZATION TECHNIQUES FOR MULTIFUNCTIONAL MATERIALS

JUNE 28 - 30, 2013

Registration Form
1. Name: ....................
2. Designation: ...........
3. Organization: .........
4. Mailing Address: ..........
................................
5. Contact No.: ... Fax: ...
6. Email: ................
7. Educational Qualification: ......
8. Experience: ............
9. Accommodation in Campus: YES / NO. If yes, select the appropriate from below,
(i) Accommodation: Hostel / Guest house

(ii) Gender: Male / Female

10. Registration Fee Details:

Amount: Rs DD No: .....
Drawn on.Branch...

Signature of Applicant:________________
Please send the filled in form to the either conveners on or before June 7, 2013
Coordinators
1. Prof. Dillip K.Pradhan, Department of Physics, National Institute of Technology, Rourkela,
Odisha-769008, (INDIA)
2. Prof. P.N.Vishwakarma, Department of Physics, National Institute of Technology, Rourkela,
Odisha-769008 (INDIA)