<p> IISc ALUMNI REUNION 2017</p><p>Registration via Cheque</p><p>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.</p><p>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. </p><p>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.).</p><p> Name: ______</p><p> Department: ______</p><p> Year of Graduation: ______</p><p> Degree (PhD, M.E., etc.): ______</p><p> Email address: ______</p><p> Phone number: ______</p><p> Number of accompanying family members (Rs. 1500/- will be charged per person): ____</p><p> 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: </p><p> Cheque amount (Rs. 1500/- per person): </p><p> Cheque date: </p><p> 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. </p><p>Signature: Date:</p>