Registrationform 328132816

							                                 REGISTRATION
Conference Registration:
         Registration fees for                             Delegates        Delegates from
                                                           from India       other countries
         Individual                                          Rs 5000           US$ 500
         Group of 4 or more from the same                    Rs 4000             US$ 400
         organization (per head)
         Students                                            Rs 2000             US$200
         ISSS Members                                        Rs 4000             US$ 400

The registration fee includes a copy of the Conference Proceedings, working lunch, tea/coffee on
all the conference days. All authors who are presenting papers are expected to register for the
technical sessions.
As a special gesture to academia we have introduced a Special Academic Package of Rs. 10,000 for
a group of five students and a teaching faculty member. Additional students will be charged at Rs
1000/- per student and additional faculty member will be charged at Rs 2500/- per faculty. The
entire amount for the group is payable in a single cheque/demand draft. No other forms of
payment will be acceptable.
The deadline for advance registration is November 30, 2011.

Pre-Conference Workshop Registration:
Separate registration is required for participating in either of the pre-Conference workshops.
         Registration fees for                             Up to Dec         After Dec 20,
                                                           20, 2011              2011s
         Individual                                         Rs 5000             Rs 6000
         Academia                                           Rs 3500             Rs 5000
         ISSS Members                                       Rs 4000             Rs 5000
Please note that the special rates would e applicable only till Dec 15, 2011. Pl. contact us for
special group discounts for group size exceeding 5.Onsite registrations will be subject to availability
of seats.

Notes:
Demand Drafts/Pay Orders/Cheques should be in favour of ISSS - 2012. Delegates outside India
should make payments through International Bank Draft payable at par at a bank in Bangalore. Any
bank commission or other charges should be included in the amount of the draft in addition to the
Registration Fee. Delegates from India should make payments through crossed bank draft/pay
order/cheque payable at par at a bank in Bangalore. The registration fee cannot be refunded.
The registration form can be downloaded from the website and filled and sent along
with the registration fee to:
          ISSS International Conference 2012
          C/o Prof. K.J. Vinoy
          Dept of ECE
          Indian Institute of Science
          Bangalore 560012
          Ph+91(80) 2360 0446 email:

Registration Form
Attending            Full day Workshop on Microfluidics (January 04, 2012) or
                     Full day Workshop on RF MEMS (January 04, 2012)
                     Conference Sessions

     Title                                          Prof./ Dr./ Mr./ Ms./ Other
     First name
     Last Name
     Organization
     Designation
     Address


     City                                           Pin
     Email
     Phone Mobile
     Fax
     Student (Students should produce a             Yes/ No
     valid ID at the time of registration)
     Accommodation Required                         Yes/No
     (subject to availability)

If bulk registration, please provide names of additional registrants in a separate sheet.

Amount:                                 Bank:
No.:                                    Date:


Signature of Participant                                               Signature & Seal
                                                                       Sponsoring authority