International Conference on The Impact of Social Changes on English Language and Literature: An Overview of Past 100 Years

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Registration Form

Lingaya’s University
Nachauli, Old Faridabad – Jasana Road
Faridabad-121002, Haryana

Inter National Conference
 on
“The Impact of Social Changes on English Language & Literature: An Over view of Past 100 Years”

7 & 8 February 2014

REGISTRATION FORM
(a photo copy of this form may also be used)


1. Name (in Block)              ………..…….……………………………………………………………………………
2. Designation… ….………………………..……………………………………………………………………
3. Organization……………………………………………………………………………………………..
(with Address)………………………………………………………………………………………………………
4. Mailing Address  ……………………………………………………………………………………………
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
Ph……                        Fax………………………………………………………….
Email………………………………………………………………………………………………………………..
Mob……………………………………………………………………………………………………………
5. Accommodation required                  □ Yes / No       
6. Registration Details
In case of  Online payment please attach the photocopy / scanned copy of the payment details .   In case of DD payment, please fill in the following details:-

DD. No…………………………………………………… Date…………………………………………………..
Amount………………………… Bank…………………………………………………………………………….
(the draft is to be made in favour of Lingaya’s University, Faridabad )
Signature of Sponsoring Authority …………………………………………………………………………………
(with office seal)

Place: …………………………………
Date: ……………………………….
                                                                                                                                                                                                                               
________________________________

Signature of Applicant

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