Mahatma Education Society’s

PILLAI HOC COLLEGE OF ENGINEERING AND TECHNOLOGY

REGISTRATION FORM FOR SHORT TERM TRAINING PROGRAMME

Title of STTP: “Application of Remote Sensing and Geographic Information System in

Disaster Management: Response , Recovery and Reconstruction

On 5th to 11th January, 2018

Participant's Details Participant's Name: Dr. / Prof. / Mr. /Ms. ___________________________________________ Educational Qualification(s): ____________________ ISTE Membership No : _____________ Designation: __________________________________________________________________ Name of the Organization: _______________________________________________________ _____________________________________________________________________________ Nature of Job: _________________________________________________________________

Communication Details Mailing Address _______________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ __________________________________________PIN : ____________________________ Tel. Off.: ___________________________ Tel. Res: __________________________________ Mobile: ______________________________________________________________________ E-Mail: __________________________________ @ __________________ . ______________

Payment Details Demand Draft No. ____________________________ Dated ________________________ Bank Name:_________________________________ Branch: __________________________

Date: ___________ Signature of the Applicant:______________________