OFF-LINE Registration Form

3rd International Conference on Microwave and Photonics (ICMAP) – 2018

Indian Institute of Technology (ISM) | Dhanbad | Jharkhand | India | Date: 09–11 Feb., 2018 | www.icmap2018.org

Section 1: Personal Details Gender

Name
Organization
Position/Designation Nationality

Address
Email
IEEE Membership Number (if any) Mobile No (if any)
Name of Accompanying Person (if any)

Section 2: Conference Registration Please indicate registration category:

On or before 31 December After 31 December No. of
Registration category Sub total
Indian Foreign Indian Foreign Registration
General INR 8,000 USD 400 INR 9,000 USD 450
General IEEE Members INR 6,500 USD 320 INR 7,500 USD 360
Student INR 5,000 USD 200 INR 5,500 USD 250
Student IEEE Members INR 4,000 USD 160 INR 4,500 USD 200
Accompanying Spouse INR 3,500 USD 150 INR 4,000 USD 200
Total Registration Fee (in words): INR/USD ..……………………………………………………………......
Please attach a copy of supporting document to avail the reduced registration fee.

Registering as Both author and presenter of a paper Author of a paper but not presenter Only attendee
Others (Please specify) ………………………………………………………………………………………

Section 3: Paper Details (APPLICABLE ONLY FOR AUTHORS PRESENTING PAPER) Each paper needs to be presented
by one of its authors and each registered author may present a maximum of two papers. ICMAP – 2018 requires registration
for every paper for presentation and publication in the conference proceeding.
Paper 1: Paper Tile
Paper ID
Paper 2: Paper Tile
Paper ID

Payment All payments are to be made by ON-LINE MONEY TRANSFER (Banks Details given Below) [please attach copy of receipt]
Details: Ref. No. _ Date of transfer
Bank (from where transfer is being made) __ Rs. (INR)
Refund Policy
• Refund up to 08th January, 2018 due to cancellation of Conference registration and / or Accommodation booking: 50% of Registration and / or Accommodation fee – Bank charges
• Refund after 08th January, 2018 due to cancellation of Conference registration and / or Accommodation booking: Nil
• Cancellation of conference registration will automatically lead to the cancellation of accommodation. All cancellation will be settled after the conference.
Disclaimer Liability The conference organizers will not accept liability for personal injury or loss / damage to property / belongings of participants or accompanying persons
occurring before, during or following the conference and its associated tours or their stay in India. It is therefore recommended that participants and accompanying persons arrange for
their own personal health, accident and travel insurance.

Registration declaration I hereby declare that all the statements made in the Registration Form are true to the best of my
knowledge and belief.
Signed by Signature Type your name for email submission Date

BANK DETAILS for Online Payment Transfer: Duly filled Registration Form along with Payment Transfer
Bank: State bank of India Proof may be email to:
Branch: Indian Institute of Technology (ISM), Dhanbad – 826 004
Account Name: ICMAP – ISM Dr. Raghvendra Kumar Chaudhary
Account Number: 32822962558 Assistant Professor & Finance Chair (ICMAP - 2018)
Branch Code: 001641 Email: raghvendra@ieee.org
MICR code: 826002006
IFSC Code: SBIN0001641
Swift Code: SBININBB388 (Dhanbad Main Branch)

FOR REGISTRATION RELATED MATTERS

Please contact: Dr. Raghvendra Kumar Chaudhary Phone: +91 7766907806 (M); +91 3262235127 (O) Email: raghvendra@ieee.org Fax: +913262235127