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PDF Icmiee 2014 Registration Form

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All attending conference participants must pay the registration fee and at least one author per paper must registrar. Without registration no paper will be published. The conference fee must be received by November 30, 2014 to assure publication.

ICMIEE 2014 REGISTRATION FORM

Title (Mr./Ms./Mrs./Dr./Prof./Prof. Dr.): ________________________

Name: ___________________________________________________________________________

University/Company: _____________________________________________________________

Address: _________________________________________________________________________

City: ____________________ State/Province: __________________ Zip Code: ______________

Country: ______________________ Telephone/Cell: ____________________________________

Email: _________________________________________________ Fax: ______________________

Paper No: ______________ (Submission no.)

Paper Title: _______________________________________________________________________

__________________________________________________________________________________

Authors: __________________________________________________________________________

__________________________________________________________________________________

Are you the presenter?  Yes  No

Name of the Presenter (if you are not): _______________________________________________

Number of Accompanying Person: __________________________________________________

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REGISTRATION FEES: (please tick on applicable one)

ICMIEE Terms

1) The undersigned represents that he/she has the power and authority to make and execute this assignment.

2) The undersigned agrees to indemnify and hold harmless the ICMIEE from any damage or expense that may arise in the event.

3) In the event the above work is not accepted and published by the ICMIEE or is withdrawn by the author(s) before acceptance by the ICMIEE authority, the foregoing publication shall become null and void and all materials embodying the Work submitted to the ICMIEE will be destroyed.

4) For jointly authored Works, all joint authors should sign, or one of the authors should sign as authorized agent for the others.

5) Because ICMIEE incurs certain expenses prior to the conference, it is necessary to impose the following cancellation policy: For cancellations received on or before November 30, 2014, ICMIEE will refund 50%

of the total registration cost (including any activity fees). No refunds of any kind will be given for cancellation requests received after November 30, 2014.

________________ ____________________________________________

Date Signature ofAuthor/Authorized Agent for Joint Authors

ICMIEE

FACULTY OF MECHANICAL ENGINEERING Khulna University of Engineering & Technology (KUET)

+880-41-769469~75(Ext. 405) | [email protected] | www2.kuet.ac.bd/icmiee2014

Foreign Authors/Participants: US$200  SAARC Country Authors/Participants: US$150  Local Authors/Participants: BDT 3500  Local Student: BDT 2000  Foreign Student US$ 100  Accompanying Person*: _________ 

*Local accompanying person: BDT 2000, Foreign: US$ 75

PAYMENT INFO (pls tick) Cash  Cheque  Payorder  DD  Date: _________________

Deposit slip Number:_________

Bank: _______________________

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