Iisc ALUMNI REUNION 2017

IISc ALUMNI REUNION 2017

Registration via Cheque

We invite all alumni who have graduated with a degree from the Institute to join us for the IISc Alumni Reunion to be held during December 16 & 17, 2017.

Please use this form if you are planning to send a cheque towards registration. All cheques must be made to "The Registrar, Indian Institute of Science". Kindly make sure you enter all the cheque details accurately in the following form.

The registration fee for each person is Rs. 1500/- (applicable for each family member as well). Depending on the total number of people accompanying you, please indicate the appropriate amount in the cheque (i.e. Rs. 3000 for Attendee + 1 family member, Rs. 4500 for Attendee + 2 family members, etc.).

 Name: ______

 Department: ______

 Year of Graduation: ______

 Degree (PhD, M.E., etc.): ______

 Email address: ______

 Phone number: ______

 Number of accompanying family members (Rs. 1500/- will be charged per person): ____

 Please confirm your attendance for the breakfast on Saturday, December 16, 2017 (tick which is applicable): (Yes/No)  Please confirm your attendance for lunch on Saturday, December 16, 2017 (tick which is applicable): (Yes/No)  Please confirm your attendance for dinner on Saturday, December 16, 2017 (tick which is applicable): (Yes/No)  Please confirm your attendance for breakfast on Sunday, December 17, 2017 (tick which is applicable): (Yes/No) CHEQUE DETAILS:  Cheque Number:

 Cheque amount (Rs. 1500/- per person):

 Cheque date:

 Cheque drawn on bank name and branch: I hereby declare that the above information is correct, and accept that my details can be added to the IISc Alumni Database.

Signature: Date: