7/25/2019 Ic2e2mit Registration

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IC2E2MIT16

11th&12

STMarch 2016

REGISTRATION FORM

Name :

Designation / Student :

Institution :

Gender (F / M) :

Mail id :

Mobile No :

Title of the Paper :

Registration Fee details (PLEASE [ ])

1 !esear"h s"holar : # M$ / MTe"h Student :

% Fa"ult& : ' $ Student :

DD Details

mount : Date :

an* Name : DD No :

ran"h :

Online !a"#ent

mount : Date :

an* Name :

!e"eipt No :

7/25/2019 Ic2e2mit Registration

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Pa"#ent Details:

In "ase of DD+ it should be dra,n in fa-or of .T$e Prin%i!al Ranganat$an

Engineering &ollege' Pa"ale at &oi#atore*+,,-.

In "ase of dire"t pa&ment the amount should be "redited to the / numbero Payee Name : SUDHAKAR G

o Payee Account Number : 28760100004547

o an! "#S$ $o%e : AR0$&RAS '#()t* c*aracter (+ ,ero-

o &"$R $o%e : 641012007

o $u+tomer "D : 066188202

o Payee an! Name : ANK .# AR.DA

o Payee an! ranc* : RS PURA& $."&A/.R

o Payee an! $(ty : $."&A/.R

o Account /ye : Sa(n3+

o Payee an! $ountry : "ND"A

The pa&ment proof should also be sent along ,ith the ppli"ation form For furtherdetails please -isit our ,ebsite (re""besite0net)

Indian Delegates2

o Industr& :IN! 134

o "ademi"ians : IN! 14

o 5G Students : IN! 3

o PG Students / !esear"h S"holars 2 IN! 1

&onta%t Details

Mr S !5N 65M!+

P / S$+

o7ordinator+ I#$#MIT718

!anganathan engineering "ollege

!e" *al-i nagar+thondamuthur+

oimbatore 7 8'110

%onta%t no: ./.-*++*0-

&$e%1 List along 2it$ A!!li%ation

!egistration form

Demand Draft or Pa&ment proofo Please ,rite &our name and "ollege name at the ba"* side of the DD