International Conference on Social Entrepreneurship 29 , 30 and 31

International Conference on Social Entrepreneurship
29th, 30th and 31st January 2015, Manipal, Karnataka, India
Registration Form
 Please use capital letters. Write name as you would want to appear on the certificate
 Payment by demand draft to be drawn in favour of Manipal University Conference/ workshop payable at Udupi /
Manipal
Name: ___________________________________________________________________________________
Gender: M/F
Designation: ___________________________________
Address: __________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Landline: ____________________ E-mail: _________________________________________________________
Mobile: _________________________ Preferred mode of communication: Post
Participant Category: Research Scholars
Email
Telephone
Academician
Non-Governmental Organizations
Industrialist/ Govt. Agency
___________________________________________________________________________
Details of payment:
Registration fee: Rs __________
DD No: _________________ Dated: ____________
Drawn on (Bank): _________________________________________ Branch: Udupi / Manipal
Unique Transaction Number : _______________________________ (In case of Online Payment)
Date:
Signature
OFFICE USE ONLY
Receipt No: ___________________________________
Date of receipt: _______________________________________
Remarks : __________________________________
Signature of Approving Authority
Mailing address: Conference Chair, Dept. of Commerce, Near 10th Block MIT Hostels, Manipal University, Manipal
Karnataka, India 576-104 Email: [email protected]
For online payment bank account details are as below (need to send the above application by post/email).
1. Beneficiary Name & Address
Manipal University Conference/Workshop
Finance Department
Manipal University
Manipal-576104
2
Bank Account Number
33508958510
3. Name of the Bank
State Bank of India
4. Branch Name & Address
Manipal Branch
Madhuvan Serai, Ground Floor
Near Smrithi Bhavan
Tiger Circle Manipal-576104
Udupi Dist. Karnataka, India
5. Account Type
SB
6. IFSC Code
SBIN0004426
7. MICR Code
576002006
8
SBININBB770
SWIFT Code
Registration fee for Indian Participants:
Till 10th November 2014
Rs. 1350
Rs. 1800
Rs. 2250
Rs. 2700
After 10th November 2014
Rs. 1500
Rs. 2000
Rs. 2500
Rs. 3000
Registration fee for Foreign Participants:
Till 10th November 2014
Research Scholars
USD225
NGOs
USD270
Academicians
USD270
Govt. Agency/ Industrialist
USD360
After 10th November 2014
USD250
USD300
USD300
USD400
Research Scholars
NGOs
Academicians
Govt. Agency/ Industrialist