6TH ASIAN LEPIDOPTERA CONSERVATION SYMPOSIUM Zoological Survey of India, Kolkata

17th-21stSeptember 2019

17th-19th September 2019 (Field Visit) 20th-21stSeptember 2019 (Conference)

Registration Form

1. Name :

2. Designation :

3. Institution :

4. Educational Qualification :

5. Title of the Abstract :

6. Interested in Field visit (Yes/No) :

(If Yes, Details of DD) : DD. No. Date: Bank:

7. Address for correspondence :

8. Gender :

9. E-mail and Fax :

10. Mobile no. :

Declaration

I hereby declare that information provided in the registration form is true to my knowledge and faith.

Date: Signature of Applicant

Place:

Signature of the PI/Head of Department/ Institution with seal

Note:Delegates interested to participate in the field workshop will have to reach in Kolkata till the evening of 16.09.2019 as we will be leaving for Field in the early morning of 17.09.2019. Others who are interested for conference only may reach at the venue i.e., Zoological Survey of India, M-Block, New Alipore, Kolkata by 20.09.2019 at 08:00 A.M.