National Council for Science & Technology Communication (NCSTC, DST), New Delhi
Vidya Deep Foundation (VDF), Satara, Maharashtra
Indian Science Writers’ Association (ISWA), New Delhi
Jan Seva Ashram (JSA), New Delhi
The 12th Indian Science Communication Congress (ISCC-2012) 
Risk Communication & Development
Indian National Science Academy (INSA)
Bahadur Shah Zafar Road, New Delhi-110002, India; December 17-21, 2012
Registration Form 
1. Name of the Delegate: 

2. Male/ Female:

3. Complete Postal Address: 

4. Contact Details:
Phone with STD/ ISD Code: 
Fax with STD/ ISD Code: 
Mobile: 
E-mail/ Website: 

5. Profession/ Affiliation: 

6. Abstract/ Paper/ Poster:
	Title: 
	Preferred Session of Presentation:
	
7. Travel 
Travel Fellowship (attach justification, if required):		Not/ Required 
Arrival Date, Time, Train/ Flight No.: 
Departure Date, Time, Train/ Flight No.: 

8. Guest House Accommodation: 					Not/ Required 
9. Delegate Category:						General/ Student/ Indian/ Foreign 
10. Name of Accompanying Person(s), if any:
Date:                                 							                          Signature: 
Important Notes:
*	The duly filled in Registration Form along with your Photo may be sent to the Secretariat (ISCC-2012) by Speed Post/ Courier at the address given below.
*	Registration Fee through a Bank Draft/ Cheque issued in favour of “Vidya Deep Foundation” and payable at “Satara Branch” may be sent to the Secretariat (ISCC-2012) by Speed Post/ Courier.
*	Abstract/ Paper/ Poster may be sent to the Secretariat (ISCC-2012) by Speed Post/ Courier 
*	Abstract/ Paper can also be sent by E-mail: editorijsc@gmail.com; vidyadeep@gmail.com
*	Registration Form and Photo can also be sent by E-mail: jsadixit@gmail.com; vidyadeep@gmail.com; iswacom@hotmail.com 
*	General queries can be addressed to: E-mail: polestar2K@yahoo.com; jsadixit@yahoo.com; Phone:  +91-9718085050; +91-9891778720.
Shri S.R. Dixit
Secretariat (ISCC-2012)
President, Jan Seva Ashram
65-E Munirka Village, Near Gurudwara, New Delhi-110067, India
         Phone: +91-11-26189137; Mobile: +91-9718085050 
E-mail: jsadixit@yahoo.com jsadixit@gmail.com; Website: www.jansewaashram.com