Registration Form
(For Phase II)
Name:………………………………….....….…………………………………………
Father/Guardian's Name:…………………......………..………………………………
Name of Institution where
studying…....................................…………………………………………………….
Name of the
University..…………………………………......……………………………………..
……………………………………………………………....…………………………
.
Name of the Zone:
WEST
Class:…………………………… Discipline:…………………………...…………….
Address for Communication:…………...………………......…………………………
……………………………….…………..……………….....…………………………
Phone: (Off)……..………….(Res)……..……………(Mob)……...…………………
Fax……………...…………..E-mail:………....………………………………………
Title of the Project:……….......………………………………………………………
………………………………......……………………………………………………
Area……….........…………………………………….....……………………………
Mode of Presentation: Model/Poster...............................………………………..
Application of the Project if done...................Yes/No
If Yes, Where and How? (Mention briefly)….....…….………………………………
…………………………………..……………….....….……………………………..
………………………………………………………......……………………………
Whether the project has been sent for some other competition
earlier? .................Yes/No
IfYes, mention place and date………........………..………….
Accommodation required: .................Yes /No
Date………. …………
Signature of Nominee
(Signature of the CompetentAuthority)
Please send the filled-in Registration Form, Demand Draft and
Abstract of the project, etc. to:
The Coordinator, Student Research Convention, Research Division
Association of Indian Universities,NewDelhi 110 002
Phone: (011) 23230059, Fax: (011) 23232131
Email:
Also send a copy of Registration form alongwith a DD for local hospitality (Rs.500/-):
Dr. A.D. Choudhary
Zonal Coordinator, SRC (West)
Rashtrasant Tukadoji Maharaj Nagpur University,
Chhatrapati Shivaji Maharaj Administrative Building,
Ravindranath Tagore Marg, Nagpur – 440 001
Email: adcngp@rdiff mail.com, Phone: 0712-2500736