NATIONAL CONFERENCE
on
Emerging Trends in Libraries & Information Services
(ETLIS - 2014)
Affix your recent
passport size photo
for issuance of
identity card
Please return the completed form to:
Shiva Prakash
Convener, ETLIS 2014 & Secretary
Jharkhand Information & Library Association
“Shiv-Shova”, Ashok Prastha,
Bye pass Road, Dibadih,
P.O. – doranda, Ranchi – 834 002
Email : jilaranchi@gmail.com
(LATEST BY JANUARY 31, 2014)
(USE CAPITAL LETTERS)
Signature of Participant
Venue: Birla Institute of Technology, Mesra, Ranchi
February 22-23, 2014
REGISTRATION FORM
Name: Dr./Prof./Mr./Ms. :
Title/ Designation:…………………………………………………………………………………………………………....
Organization/Institution : ……………………………………………………………………………………………...........
Mailing Address : ………………………………………………………………………..........…………………………......
…………………………………………………………………………………………………………………………….......
P.O. …………...…………… City: ………………...……….PIN Code……….....………State:…………...............……
Telephone/Mobile : ……………………..........……………………………………………………………………………...
E-mail : …...…………………………………………………………………………………………………………………..
Title of the Paper for Presentation : …………………………………………………………………………………………
Category: (Tick üor û) : Working Retired Student Others (Specify)……………......………….
Accommodation Required : YES NO Accommodation for (No. of Persons)………......................…….
Payment Details :
Payment in favour of : Jharkhand Information & Library Association
Cheque /DD No. : ……….………………………...………….Date: ………......………Amount ….…….............……
Name of the Bank : ……….………………….......…................................…………….Drawn on……….............……
ECS Details :
(1) Amount
(2) Transaction No.
(3) A/c from which the payment is made
…………………………………………………………………………………………………....
Date : ....................................
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