One Day National Seminar

on

“Application of Geosynthetics for Infrastructural Development”

2nd January, 2019
Organized By:
Applied Mechanics Department, Vishwakarma Government Engineering College
Nr. Visat Three Roads, Chandkheda, Ahmedabad-382424, Gujarat, India.

Registration Form

Name:__________________________________________________________________

Designation:________________________Highest Qualification:___________________

Institute’s Name:_________________________________________________________

Address:________________________________________________________________
_______________________________________________________________________

Gender: Male/Female_______________Experience:__________________________

Contact Details:
Phone No.:__________________________ Email Id:____________________________

Cheque/Demand Draft Details:

Number: _________________________ Date:____________________________
Amount: ______________ Drawn on:____________________________________

Sign of the participant

Certificate

This is to certify that Mr./Ms./Mrs.___________________________________ is working

as a/an ______________________in__________________________ Department of this
Institute. He/She will be permitted to attend this one day National Workshop, if selected.

Authorized signatory With Stamp and Seal