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GENERAL INFORMATION: |
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Full Name*
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Email*
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Current Position*
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Affiliation* : |
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Sex: |
Male |
Female
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Postal Address: |
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City: |
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State: |
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Country: |
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ZIP/PIN Code: |
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Phone: |
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Cell Phone: |
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Fax: |
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Date of birth: |
Date |
Month |
Year |
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Place of birth: |
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FOR
FOREIGN NATIONALS: |
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Nationality: |
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Passport Number: |
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Date of issue of passport: |
Date |
Month |
Year |
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Place of issue of passport: |
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Expiry date of passport: |
Date |
Month |
Year |
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Anticipated date of arrival in India: |
Date |
Month |
Year |
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Anticipated date of departure from India: |
Date |
Month |
Year |
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OTHER INFORMATION: |
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Submitting ABSTRACTs
(please see the Abstract link for details): |
Yes
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No
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Attending QGP School
(please see the QGP School link for details) |
Yes
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No
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Applying for Financial Support
(please see the Support link for details) |
Yes |
No |
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Number of Accompanying persons: |
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PAYMENT: (1)
REGISTRATION FEES: |
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PAYMENT: (2)
ACCOMMODATION BOOKING |
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Arrival at
Jaipur: |
Date |
Month |
Year |
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Departure from
Jaipur: |
Date |
Month |
Year |
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Hotel Requested
for
nights.
Select the hotel from the list: |
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Deposit for One
Night: US $ |
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For details about the hotels please see the
ACCOMMODATION link in the webpage. |
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TOTAL PAYMENT |
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Please make your final payment by one of
the following methods: |
CREDIT CARD (Visa / Mastercard):
| You will be directed to the
Credit Card link after pressing the SUBMIT
button at the end of the page.
Please follow the steps to PAY
by Credit
card using this procedure. |
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BANK TRANSFER:
| Beneficiary's Bank: ICICI
Bank |
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Bank Address: ICICI Bank,
AC-4, Sector-1, Kolkata-700064 |
| SWIFT Code: ICICINBBNRI |
| Beneficiary's Account No.:
030501001131 |
| Please indicate: YOUR NAME
and QM2008 |
| After actual payment, kindly
send an email to qm2008@veccal.ernet.in
with the Bank Transfer details
(Date and your Bank name) for
confirmation. |
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CHECK / BANK DRAFT / MONEY ORDER (please
don't send personal cheque)
| Payable to:
QUARK MATTER 2008 |
| Mailing
Address: |
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Convener, Quark Matter 2008 |
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Variable Energy Cyclotron Centre |
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1/AF Bidhan Nagar |
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KOLKATA - 700064, India |
| After sending the
check/draft/money order, kindly
send an email to qm2008@veccal.ernet.in
with the details (No. and Date
of issue) for confirmation. |
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PAYMENT UPON ARRIVAL
| Late Registration fee will
be applicable. |
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MESSAGE TO THE ORGANIZERS:
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