27TH NAOP ANNUAL CONFERENCE, 2017 REGISTRATION FORM
1. Name (In capital letters):
_________________________________________________
2. Gender: ⃝ Male ⃝Female ⃝ Other
3. Designation: _______________________________________
4. Institution/ University/ Organisation and Location:
(e.g. Indian Institute of Technology Kharagpur, Kharagpur)
_______________________________________________________________
5. Full address with postal code:
_____________________________________________________________________
___________________________________________________________
6. Email id: _______________________________________________________
7. Mobile phone No. /Landline No.:_____________________________________
8. Registration type:
⃝ Early Bird ⃝ Regular ⃝ On-Spot
9. Are you a member of NAOP?
⃝ Yes ⃝ No
10. NAOP membership number/email id (if applicable) *
(If not applicable, please mention NA. If you don't remember your membership
number,
kindly mention the email ID you had provided while taking membership for our
verification).
_______________________________________________________________
11. Registration category
(Students are required to submit either bonafide certificate or photocopy of ID).
⃝ Academician / Faculty Member
⃝ Industry Professional
⃝ Research Scholar
⃝ Student
⃝ International Delegate
⃝ Accompanying Person - Indian
⃝ Accompanying Person – International
12. Are you attending any Pre-conference workshop?
⃝ Yes
⃝ No
13. Title of the Pre-conference workshop (if attending)
(All Pre-conference workshops will take place simultaneously; hence, one participant
may register only for one workshop).
⃝ Workshop 1
⃝ Workshop 2
⃝ Workshop 3
⃝ Workshop 4
⃝ Workshop 5
⃝ Workshop 6
⃝ None
14. Registration fee
(Please mention registration fee applicable to your category).
____________________________________________________________________
15. Pre-conference workshop fee *
⃝ Rs. 1500 (Half-day workshop)
⃝ Rs. 2000 (Full-day workshop)
⃝None
16. Total amount paid (Registration fee + Pre-conference workshop fee if any)
____________________________________________________________________
17. Date of transaction
____________________________________________________________________
18. Issuing Bank and Branch
____________________________________________________________________
19. NEFT UTR Number/ DD Number/Transaction Number
____________________________________________________________________
20. Do you need accommodation?
⃝ Yes
⃝ No
21. Please mention the type of accommodation you would like to have (to know the types
of accommodation available please visit
[Link]
____________________________________________________________________
22. Author of any paper(s)?
⃝ Yes
⃝ No
23. Co-author of any paper(s)?
⃝ Yes
⃝ No
24. Details of Paper(s):Title, Paper ID, Author(s), Track
(Mention "NA" if not applicable).
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
25. Which of the above paper(s), you are the presenter?
(Mention title of paper(s) or Paper ID. Non-presenters and others, please mention NA)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Important:
Please complete this form and to confirm your participation, post the demand draft or proof
of payment transfer (with your name and contact number clearly mentioned on it) along with
this form to the following address:
Dr. Rabindra Kumar Pradhan
27th NAOP Annual Conference 2017
Department of Humanities and Social Sciences
IIT Kharagpur, Kharagpur – 721302
West Bengal, India.
Phone:03222-282346.
Additionally, students should also send bonafide certificate/ photocopy of ID.
For any query please send an email to naopiitkgp2017@[Link]