logic- application form

CUTN, IITM & KSOM jointly presents
Workshop on Logic
for Research Scholars & Faculy members of Mathematics and Computer Science
March 29 - April 1, 2018
KSOM, Kerala
(Funded by KSOM)

Application form

* required field.

1. Personal Details:

Name *

Gender * Male Female

Date of Birth *

Adhaar number

2. Academic Details:

Presently a * of *

Institute/University/College Address * State * Pincode: *

Specialization *

Academic records *

	Course	Institute of Study (with District & State)	Year of Passing
i
ii
iii	MPhil
iv	PhD

3. Have you participated in any mathematical activities like workshops or conference? Please give details like organizing institute, no. of days, website, etc., *

4. Are you a recipient of any merit scholarship or any certificates of merit? Please give details. *

5. Why do you want to attend this workshop? *

6. Personal Contact Details:

Address * State * Pincode *

Phone number * E-mail *

7. Recommending Teacher Details:

(Only for MPhil/PhD Scholars)

Name E-mail

8. Photo (upload your recent photograph) : *

(Only passport size photograph to be uploaded in JPEG / PNG / JPG format and below 700kb size)