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Satish Dhawan Space Centre SHAR, Sriharikota

Indian Space Research Organisation

Challenges & Modern Techniques in


Realising Complex Infrastructure
on
th
5 March 2018

REGISTRATION FORM

Name…………………………………………………………………………………………………………………………………………………………

Organisation/Insitution……………………………………………………………………………………………………………………………..

Designation……………………………………………………………………………………………………………………………………………….

Address……………………………………………………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………………………….

Mobile……………………………Telephone……………………………Fax………………………Email…………………………………….

Accommodation –Required/Not required

Travel details: 1.Date of Arrival ………………………2.Date of departure…………………………….3 Mode of Transportation


Own / Pick up required in sullerpet

Registered Category:

Delegate Academic □ Student □

*Tick the boxes as per your category /strike out whichever is not applicable
Payment Details

I/We enclose a Demand draft for Rs………………………..(in figure)(Rs………………………………………………..............

…………………………………………………………….only)(in words) in favor of “ISSE sriharikota Chennai chapter”

payable at shriharikota & drawn on (Bank particular) ……………………………………………………… Demand draft

No……………………….. Dated…………………………

Transaction ID/UTR No/Payment Reference No:…………………………………………………….

Transaction Date…………………………………………Amount(Rs):…………………………………………………………………………………….
Satish Dhawan Space Centre SHAR, Sriharikota
Indian Space Research Organisation

Date…………………. Signature…………………………………