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GITAM Institute of Pharmacy Registration Form

The document is a registration form for LINCTUS2K14, a seminar and workshop hosted by GITAM Institute of Pharmacy at GITAM University in Visakhapatnam, India. It requests information such as the registrant's name, date of birth, designation, institution, contact details, payment details, and signature. It specifies that the registration fee is Rs. 300 and the deadline for payment is March 10, 2014.

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24 views1 page

GITAM Institute of Pharmacy Registration Form

The document is a registration form for LINCTUS2K14, a seminar and workshop hosted by GITAM Institute of Pharmacy at GITAM University in Visakhapatnam, India. It requests information such as the registrant's name, date of birth, designation, institution, contact details, payment details, and signature. It specifies that the registration fee is Rs. 300 and the deadline for payment is March 10, 2014.

Uploaded by

g20kp
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

GITAM INSTITUTE OF PHARMACY

Approved by PCI u/s 12 of pharmacy act,1948


GITAM UNIVERSITY
(Estd, u/s 3 of UGC Act 1956)
Accredited by NAAC with A grade
Gandhinagar Campus, Rushikonda, Visakhapatnam 530 045

Name: ______________________ ______________________________________ _____________________________


(Initial)
(First name)
(Last name)
Date of birth: ____________________ (dd/mm/yr)
Branch:
[Link]
[Link]
Others
Designation: Student
Staff
Name of the college______________________________________________________________________________
GPAT Hall ticket no: ___________________________
Email id: _______________________________________________________________ @________________________
Mobile no: ________________________________ Land Line no: _______________________________________
Address for correspondence: __________________________________________________________________
_____________________________________________________________________
City: _________________________________________ Pin code: __________________________________________

Registration fees: Rs. 300/Payment details:


Cash
D.D
Amount paid: Rs________/- in words ____________________________________________________________
D.D. no: ____________________________________________________________________________
Bank details: ____________________________________________________________________________________
*Note: D.D drawn in favor Seminar and workshops-GIP, GITAM University payable at Visakhapatnam,
should reach the convener LINCTUS2K14, GITAM Institute of Pharmacy, GITAM University,
Visakhapatnam-530045, Andhra Pradesh, India on or before 10th March, 2014.

Please tick the following, if applicable:


Poster presentation
Applied for GPAT
Certified that ____________________________________________________ is a bonafide student of
_____________________________________________________________________________ institute/University.

Signature of the Head of the Institute

Signature of the candidate

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