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Participant's Name:

Type of Participant:

Department Name:

Designation:

Organisation / Institution Name:

Organisation / Institution Address:

Telephone No:

Mobile No:

Email ID:

Mailing Address:

Telephone No:

Mobile No:

Registration Fee
Industry Participants	Rs.2000/-
Academic Participants	Rs.1000/-
Student Participants	Rs.500/-

Note: fee is payble by 31 January 2012 by DD/Crosssed Cheque in favour of J.D.Birla Institute (Management Section) Payble at Kolkata. Please write your name at the back of the cheque/DD.