M.S. Ramaiah Institute of Technology
(Autonomous Institute, Affiliated to VTU)
M.S. Ramaiah Nagar, MSRIT Post, Bangalore 560 054, Karnataka, INDIA
Phone : +91 80 2360 0822, 2360 6934
Fax : +91 80 2360 3124
Web : www.msrit.edu
REGISTRATION FORM
Faculty Training Program
Workshop on
NuMicro ARM Cortex-M0 and its Applications
www.nuvoton.com
Under Technical Education Quality Improvement Programme (TEQIP-II)
10th -11th September, 2013
Name of the participant: …………………………………
Designation: …………………………………………………….
Qualification: ……………………………………………………
Experience: …………………………………………………..…
Name and Address of Organization:
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Address for Communication:
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Email…………………………………………………………..
Telephone with STD Code
Office: ……………………………
Residence: ……………………………….
Mobile: ……………………………….……………..
Registration Fees Details: The registrants are required to submit with the application form a
registration fee through a DD drawn in favour of “The Principal, MSRIT” payable at Bangalore.
DD No: …………………………..
Date: ………………..
Bank: ……………………………………………
Amount: ……………………………………………
Signature of the Applicant
Signature & Seal
Head of the Institution