Celebrating 5 years of journey towards Excellence in School Education EDUCARNIVAL 2014 December 26 th -30th 2014, IIT Delhi IIT DELHI School/Company/Organisation/Institution Details Name: __________________________________________________________________________________ __ Date of Birth (DD/MM/YY) : _____________________________ Gender: Designation ____ _____________________ Male Fem ale Postal Address: _____________________________________________________________________________ __________________________________________________________________________________________ City: _________________________ Pin Code: _____________________ Country: _____________________ NOMINATION FORM School Name/ Organization: _______________________________________________ ____________________ Telephone No: _______________________________________ Fax No: _______________________________ Mobile No: _________________________________________________________________________________ Email Id: ___________________________________________________________________________________ Please Inform/Share: (Your previous association with us) 1.) International Conference (2009) (2010) 2.) Management Imperatives For Educational Institutions 3.) International Study Tour UK (Tick Multiple , if required) (2011) 2011 USA (2012) 2012 AUSTRALI A (2013) 2013 2014 Year………………... Please Note: If you are ticking more than 2 boxes for conference attended, please contact 8588864219/8588864217 for your special gift Want to Register for National Conference on cyber safety in Schools (26 Dec) Workshop 1 – Financial Mantas for School Principals (27 Dec) Rs 2500 per participant Rs 5000 per participant Workshop 2 – Green India starting with Greener Schools (27 Dec) th 6 International Conference for School Principals (28-30 Dec) Rs 2500 per participant Rs 5000 per participant Payment Details Cheque/Demand Draft no.________________of______________________________________Bank, dated_______________ For Rs._____________ in favor of “Eduexcellence Conference” If sponsored by organization: Signed by sponsor: Name of sponsoring authority: Phone No. of sponsoring authority : (O) __________________ (Mobile) ______________ _____________________________ (Note: Use copy of this form in case of more than one participant)