REGISTRATION FORM CPTN, 2017

Name :DAWOOD RASHID

Designation: :Student (B.Tech, 5thSem)
Institute: :National Institute of Technology, Hazratbal, Srinagar
Subject/Specialization : Chemical Engineering
Teaching/Industrial Experience : NIL
Contact No: : +919858925466
Email ID : dawoodrashid5715@gmail.com

Registration Fee Details: Amount Rs.1000/= for external applicants i.e other than NIT Sgr.
(All students/ research scholars (external or internal) are however exempted from any fee).

Mode of payment: DD favouring Director, N.I.T Srinagar or cash payment at registration

desk.

Full details of DD : Date of Payment:

Signature of Applicant

CERTIFICATE FROM THE HEADOF THE INSTITUTION/DEPARTMENT

Above details are endorsed by the undersigned. Moreover the applicant is allowed to
participate in the Workshop titled “Connecting People to Nature” scheduled during
25th– 29th September, 2017 at NIT Srinagar if selected.

(Seal and Signature)

HOD/Head of Institute