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Registration Forms

 
 
REGISTRATION/ACCOMMODATION REQUEST FORM
Name Dr/Mr/Ms _________________________________________________________________

Designation       _________________________________________________________________

Organisation      _________________________________________________________________

Address            _________________________________________________________________

                        _________________________________________________________________

                        _________________________________________________________________

Nationality __________  Telephone _____________ (Office) ___________ (Residence)

Fax ________________  Email   ___________________________________________

Passport details (for foreign delegates)

Passport no __________  Date of expire _________  Place of issue ________________

Blood  group _________  Medical history (if any)  ______________________________
                                                                              ______________________________

Arrival Date _________ Time _________  Place ___________  Mode ______________

Departure Date _______Time__________ Place ___________  Mode _____________

Hotel preferred __________________________________________________________________

No of persons accompanying ______________________________________________________

Share a twin room with another participant? (indicate the name) __________________________

______________________________________________________________________________

*Mode Of Payment of fees (for registration) 

Cheque/DD _______  No ________________  Drawn on ____________ Dated _________
Payable at  : State Bank of India, Dona Paula, Goa 403004, India (for DD)

SWIFT NO  SBIN IN BBA 120
* in favour of chairman, Local Organizing Committee, PORSEC 2000.
 



 
 
Application Form For Training Course On Remote Sensing (PORSEC-2000)
Name _____________________________________________________________________________

Male/Female _________________________  Age & Date of birth _____________________________

Nationality____________________________ Marital satus __________________________________

Present occupation and affiliation _______________________________________________________

Address for communication (include phone, fax, e-mail) _____________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Passport number, date of expiry and place of issue ________________________________________

__________________________________________________________________________________


Academic Qualification details
____________________________________________________________________________________
 

Year Name of the
Academic
Degree
Name of the University Place 
and
Country
Subject of Examination  Grade
_________________________________________________________________________

Professional Experience        __________________________________________________________

Experience in remote sensing __________________________________________________________

Present activity                     __________________________________________________________

Order of preference of course topic

  • Ocean color                                                         _____________
  • Microwave remote sensing for ocean application      _____________
  • High resolution sensor products for coastal studies  _____________
Mode of Payment 
  • Demand draft drawn in favour of LOC  PORSEC-2000. Payable at State Bank of India, Dona Paula, Goa-403 004, India

  • Cheque/DD _______  No ________________  Drawn on ____________ Dated ________
     

  • SWIFT No : SBIN IN BBA 120 

  • Favour of Chairman, Local Organising Committee, PORSEC 2000