Tea County, Munnar, Kerala, India

                               

1. Personal Data

Name : Mr/Mrs/Miss/Dr .........................................................

Date of Birth : ....................Qualification : ..............................

Institution : ..............................................................................

Address for Correspondence : ................................................

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FAX : .......................E-mail : ....................................................

Telephone : (O) ..................................(R) ................................

2. I / We need accommodation YES / NO

Accompanied by (if any) :.........................................

3. Electrochemical instrumentation available

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4. Area of Interest in Electrochemistry

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5. ISEAC Member Yes / No

6. Reg. Fee Rs. ..............., Accommodation Charges. .................

Total Amount Rs.............................. DD No. .............................

Date : ........................ Signature ………………………

NOTE : Please send the above proforma duly filled along with Demand

Draft to Convener, Organising Committee at Mumbai.