PLATINUM JUBILEE 75th ANNUAL CONFERENCE
OF
THE INDIAN MATHEMATICAL SOCIETY (IMS)
December 27, 2009 to December 30, 2009
REGISTRATION FORM
________________________________________________________________________________________
1. Full Name (BLOCK LETTERS) : _______________________________________________
2. Sex: Male / Female : _____________
3. Educational Qualifications: ________________________________________
4. Designation : __________________________________________________
5. Office Address : ______________________________________________________
_____________________________________________________________________
6. Address for Communication : _____________________________________________________
_____________________________________________________ PIN : ____________________
7. E-mail ID : _______________________________________________________
8. Telephones / Fax : _________________________________________________
9. Do you want to present a paper ? Yes / No : __________
If yes, Title : ___________________________________________________________________
10. Do you need accommodation ? Yes / No : __________
11. Registration Fees : Amount: ____________ DD No.: _______________ Dated: ____________
Date: ____________ Place: ______________ Signature of the Applicant: _____________________
________________________________________________________________________________________
Completed Registration Form along with DD to be sent to :
Dr. S. Arumugam, Local Secretary, Platinum Jubilee 75th IMS Conference,
Director, n-CARDMATH, Kalasalingam University, Anand Nagar, Krishnankoil – 626190,
(Via) Srivilliputtur, Dist. Virudunagar (TN), India.
Contact : (O) : 04563 – 289 303 : (M) : 0-98940 27224
E-mail: s.arumugam.klu@gmail.com
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