National l Seminar on "Pharmacy Regulation for meeting the demand of our Nation"


Go to content

Registration Form

Archive > International > New Developments in Pharmaceutical Research & Education

REGISTRATION FORM

To,
The Convener
International Seminar on "New Developments In Pharmaceutical Education & Research"
Calcutta Institute of Pharmaceutical Technology & AHS. Banitabla, Uluberia, Howrah -711316, West Bengal, India.

Name
(Mr/Mrs./Ms/Dr.)…………..…………….....................................................

Designation:…………………................…………………………………...

Institute:……………………………….........................................................
.
Qualification:…………………………........................................................
Student ( ) Faculty ( ) Industry Participant( ) (Tick)
Address for correspondence:
…………………………….....................…………………………….……
………………………………………...............…………………………..
………………………………………….....................................................
State:……………………………………....................................................

Pin Code:……………………………................……………………….….

Email :………………………………….....................................................

*Phone No with STD code
Office: …………………………………..............................................…..
Residence:…………...……………….......................................................

Mobile No: .................……………………………………………..……

*Details of registration Fee:
DD No:…………………...................……Dated:……………………….
Drawn on….......………..for Rs……………...........



Signature


Back to content | Back to main menu
Tracker
Web Counter