International Symposium on a Sustainable Future, January 11-13, 2010

Registration Form

Date: / / 2009

Deadline: December 10, 2010

(please note that registration will not be is accepted after the deadline)

Name: _______________________________________________________________________________________________________________

(Family ) (First) (Middle)

Organization & Address: _______________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Phone: __________________________________ Fax: ___________________________ E-mail: ________________________________

Arrival date: _______________________________________________Departure date ___________________________________________

Registration Fee Payment Details :

Pay Order/ Demand Draft/Cashier Cheque No.: _______________________________________Dated: ____________________________

(All fees must be paid in equivalent Indian Rupees (INR) by Pay Order/ Demand Draft / Cashier’s Cheque, drawn in the name of “Indira Gandhi Institute of Development Research, Mumbai, India” and should be payable at par in Mumbai, India).

Participants from	India and Developing Countries	Developed Countries
Registration Fee * (No Accommodation)	INR 5000	INR 10000
Registration Fee** (With 3 Star Accommodation)	INR 20000	INR 25000
Registration Fee** (With 5 Star Accommodation)	INR 25000	INR 30000

Note: * Registration Fee includes the cost of symposium material, lunch on symposium days, morning and evening tea/ coffee.

** Fee with Accommodation includes subsidized accommodation for three nights with all meals.

(Currently exchange rate - One US Dollar = INR 50 (Indian Rupees)

Applicable only if Presenting a Paper:

Paper Title: ________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

Author (s): _______________________________________________________________Presented by _______________________________

Consent for publication: I/We hereby take the responsibility for the contents and any issue related to the copy right of the paper entitled as above. I/We also agree to get the paper published in any volume like proceedings, book, monograph, journals, etc. as to be decided by the Organizers.

Name and Signature of the Sole/First Author (on behalf of all authors)_______________________________________________________

Applicable for Delegates from Abroad:

Passport Details: __________________________________________________ Visa Details : _____________________________________

Signature of the Participant: __________________________________________________________________________________________