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JAGRAN INSTITUTE OF MANAGEMENT, KANPUR (An Autonomous Institute Approved by AICTE, Ministry of H.R.D.,Govt. of India & Affiliated to Dr.APJ A.K.T.U., Lucknow)
“1st International Conference on Innovation in Multidiscipline of
Management & Information Technology”
REGISTRATION FORM – ICMMIT 2018
Date: - 23rd & 24th February, 2018
Please register me for the conference as: Academicians / Research scholars & Students /Industry Delegates
First Name: ___________________Middle Name____________________Last Name _________________
Address: ______________________________________________________________________________
City __________________Pin Code___________ State_______________ Country ___________________
E-mail ____________________________________________Mobile _______________________________
Organization ∕ College ∕ University: ___________________________________________________________
Presenting paper Yes No Participating: Yes No
Title of the Paper _______________________________________________________________________
______________________________________________________________________________________
Co-authors, if any 1. ____________________________ 2. ______________________________________
Mode of Payment: Electronic Transfer/ Demand Draft /Cash
Credit: Jagran Institute of Management, Kanpur.
A/C No. 29640200000023
Bank: Bank of Baroda, Branch: Bara Bye Pass, Kanpur
RTGS/NEFT: IFSC Code: BARB0BARRAB (fifth character is “zero”)
Amount (in figures): ____________ Amount (in Words): __________________________________________
D.D. No.∕ Transaction No.___________________________________________Date ___________________
Drawn on Bank __________________________________________________________________________
Date: ________________________
Place: _______________________ _____________________________
Signature of the Author
Please send the filled Registration Form (Scanned copy) through E-mail: [email protected].
Copyright Form Please compile this form, sign and send to us at [email protected]
Paper Title
Paper ID
Author Name
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I,……………………………………................... the author of the research paper titled “.........................................................................................................................................” authorise you to publish the above mentioned paper in proceeding of ICIITM2018. The undersigned agreed that:
1. I will not publish this above said contribution anywhere else without the prior written permission of the publisher unless it has been changed substantially.
2. I declare and warrant that this contribution is original, except for such excerpts from
copyrighted works as may be included with the permission of the copyright holder and author thereof, that it contains no libellous statements, and does not infringe on any copyright, trademark, patent, statutory right, or propriety right of others.
3. The Author also warrants that he or she has the right to enter into this Agreement,
the Article contains no libellous or unlawful statements, contains no instructions that may cause harm or injury and does not violate the copyright or trademark, or infringes on the rights or the privacy of others; and that all statements in the Article asserted as facts are either true or are based upon reasonable research.
4. I agree to indemnify the Editors (IC-MMIT2018) against all claims and expenses
arisingfrom any breach of warranty from us in this agreement. Author Full Name with Signature____________________________________________ Date:
The authors who have contributed more than one paper are requested to submit separate copyright form for each paper.
All authors need to sign this copyright form individually.