Name	:
Affiliation	:
Designation	:
Address for Communication	:
Date of birth	:
Place of birth	:
Email id	:
Cell Phone number	:
Gender	:	Male Female
Are you a research scholar/student?	:
Are you presenting a paper?	:	Yes No
If yes, title of the paper	:
Are you a member of IMS	:	Yes No
If yes, membership no.: (non members of IMS shall take sessional membership at the venue of the conference)	:
Expected date of arrival	:
Expected date of departure	:
Do you need accommodation for your stay (accommodation is free)	:	Yes No
Your food habit	:	Vegetarian Non Vegetarian
Details of registration fee paid (DD of Rs. 1500/- should be taken in favour of "RAJAGIRI SCHOOL OF ENGINEERING & TECHNOLOGY", Cochin)
Name of the Bank	:
Amount paid	:
DD issued on (date)	:
Any other details you want to furnish	:
DD should be be sent to:(write your name on the other side of DD) Dr.Vinod Kumar.P.B Local Organising Secretary 79th IMS Annual Conference Rajagiri School of Engineering & Technology Rajagiri Valley.P.O Ernakulam Disrict Cochin 682039, Kerala, India