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<?php
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require_once("php/listAe.php");
$rahul = new rahul(); //**--Base Class rahul Object --**//
?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
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<title>--7th Science Conclave --</title>
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<script type="text/javascript">window.onload=window.print();</script>
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<table width="100%" border="0" align="center" cellpadding="0" cellspacing="0">
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<td valign="top" > </td>
<td valign="top"><form name="userFrm" action="" method="post" onsubmit="return validateUser(this);">
<table width="100%" border="0" align="center" cellpadding="0" cellspacing="0">
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<td valign="top" > </td>
<td valign="top"><table width="99%" cellpadding="0" cellspacing="0">
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<td colspan="3" ><table width="100%" border="0">
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<td><img src="scienceConclave.png" alt="Science Conclave" width="80" height="100" align="middle" /></td>
<td align="center" class="thickBorder"><p align="center" class="style9"> SEVENTH SCIENCE CONCLAVE - 2014
<p align="center" class="style10"> Organized by
<p align="center" class="style7 style8">Indian Institute of Information Technology- Allahabad, India
<p align="center"><strong>December 08-12, 2014</strong></td>
<td align="right"><img src="iiita.png" alt="IIITA Logo" width="80" height="100" /></td>
</tr>
</table></td>
</tr>
<tr align="center">
<td colspan="3" class="style7 style8"><u>REGISTRATION FORM </u> </td>
</tr>
<?php if($recordId){?>
<tr>
<td width="21%" height="30" align="left" bgcolor="#FFFFFF" > <strong>Registration Id</strong></td>
<td width="67%" align="left" bgcolor="#FFFFFF"><strong><?php echo $registrationId?></strong></td>
<td width="12%" rowspan="3" align="left" height="30" class="thickb" bgcolor="#FFFFFF"><p align="center">Paste your</p>
<p align="center"> passport photo</p></td>
</tr>
<?php }?>
<tr align="left" bgcolor="#FFFFFF">
<td height="20" colspan="2" valign="bottom" > <strong>Applicant's Personal Information</strong></td>
</tr>
<tr>
<td height="19" colspan="2" align="left"> </td>
</tr>
<tr>
<td colspan="3" ><table border="1" align="center" cellpadding="2" cellspacing="2" width="100%">
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td width="17%"><strong> Name :</strong></td>
<td width="40%"> <?php echo $firstName;?> </td>
<td width="9%"><strong>Age :</strong></td>
<td width="34%"> <?php echo $age;?></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td width="10%" align="left" ><strong>Gender :</strong></td>
<td width="19%" ><?php if($gender==0){?>
Male
<?php }?>
<?php if($gender==1){?>
Female
<?php } if($gender==2){?> Others<?php }?></td>
<td width="38%" align="left" > <strong>Name of the University / Institute :</strong> </td>
<td width="33%" align="left" ><?php echo $nameOfUniver?></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td><strong>Address for Correspondence :</strong>
<?php echo str_replace("\n","<br />",$commAddress)?>
</td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td width="13%" align="left" ><strong>Mobile : </strong></td>
<td width="16%" align="left"><?php echo $mobile?></td>
<td width="11%" align="left" ><strong> E-mail :</strong><strong></strong></td>
<td width="60%" align="left" ><?php if($email){echo $email;} else {echo "N/A";}?></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td><strong>Emergency Contact :</strong>
<table width="100%" border="0">
<tr>
<td width="8%"><strong>Name </strong></td>
<td width="31%"><?php if($emergencyName){echo $emergencyName;} else {echo "N/A";}?></td>
<td width="11%"><strong>Relationship</strong></td>
<td width="50%"><?php if($emergencyRelation){echo $emergencyRelation;} else {echo "N/A";}?></td>
</tr>
</table>
<table width="100%" border="0">
<tr>
<td width="8%"><strong>Mobile</strong></td>
<td width="25%"><?php if($emergencyMobile){echo $emergencyMobile;} else {echo "N/A";}?></td>
<td width="8%"><strong>Email</strong></td>
<td width="26%"><?php if($emergencyEmail){echo $emergencyEmail;} else {echo "N/A";}?></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
<tr>
<td align="left" > <strong>Applicant Status : </strong></td>
<td align="left" ><?php if($participantStatus==2){ echo "Teacher";} else if ($participantStatus==1) {echo "Student of PhD"; } else {echo "Student of M.Sc/M.A, final year";}?></td>
<td width="12%" align="left" bgcolor="#FFFFFF"></td>
</tr>
<tr>
<td align="left" > <strong>Areas of Study :</strong></td>
<td align="left" ><?php echo $areaOfInterest ?> </td>
<td width="12%" align="left" bgcolor="#FFFFFF"></td>
</tr>
<tr >
<td colspan="3" ><strong> ACADEMIC RECORD </strong></td>
</tr>
<?php if($participantStatus==0||$participantStatus==1){ ?>
<tr>
<td colspan="3" align="left" <?php if($participantStatus==0 ||$participantStatus==1){ ?>class="thickb" <?php }?>><table width="100%" border="0" >
<tr>
<td width="100%"><strong> Records of Last Exams Passed:</strong>
<table width="100%" border="1">
<tr>
<td width="33%" valign="top"><strong> Name of Exam </strong></td>
<td width="32%" valign="top"><strong> University / Board </strong></td>
<td width="35%" valign="top"><strong> Rank in Class</strong></td>
</tr>
<?php if($participantStatus==0){?> <tr>
<td><strong>M.Sc/M.A. First Year (for Final year Masters Degree Students only)</strong></td>
<td align="center">--</td>
<td><?php echo $division1?></td>
</tr><?php }?>
<?php if($participantStatus==1){?> <tr>
<td><strong>M.Sc/M.A. Final Year(for Phd students only)</strong></td>
<td><?php echo $university2?></td>
<td><?php echo $division2?></td>
</tr>
</table></td>
</tr><?php }?>
</table></td>
</tr>
<?php }?>
<?php if($participantStatus==2){ ?>
<tr>
<td colspan="3" align="left" valign="top"<?php if($participantStatus==2 ){ ?>class="thickb" <?php }?> ><table width="100%" border="0">
<tr>
<td width="100%"></td>
</tr>
<tr>
<td><table width="100%" border="0">
<tr>
<td width="27%"> <strong>Total experience in years : </strong> </td>
<td width="26%"><?php echo $yearinTeaching?></td>
<td width="17%"> <strong>No. of publications : </strong></td>
<td width="30%"><?php echo $noOfPubJournals?></td>
</tr>
</table></td>
</tr>
<tr>
<td> </td>
</tr>
</table>
</td>
</tr>
<?php }?>
<?php if($participantStatus==0){?>
<?php }?>
<td colspan="3" class="thickBorder"><table width="100%" border="0">
<tr>
<td width="8%"><strong> Date:</strong></td>
<td width="42%"> </td>
<td colspan="2" align="center"><strong>Signature</strong>:</td>
</tr>
<tr >
<td colspan="4"><strong>Sponsorship:</strong></td>
</tr>
<tr valign="top">
<td colspan="4"> The information provided by the applicant is correct & the university nominates the applicant. </td>
</tr>
<tr>
<td colspan="3"><p><strong> Signature and Seal of HOD:……………………</strong></p>
<p><strong> Department ………………………………. </strong></p></td>
<td width="47%"><p><strong>Signature and Seal of Vice Chancellor:……………………</strong></p>
<p> </p></td>
</tr>
<tr>
<td colspan="4"><strong> Note: </strong>
<ul>
<li> The scanned copy of filled forms, duly sponsored by HoD and VC, should be sent to <a href="mailto:scienceconclave@iiita.ac.in"> scienceconclave@iiita.ac.in</a> by 15 Oct, 2014</li>
<li> The hard copy of the form should be sent to : <strong>Science conclave, Indian Institute of Information Technology-Allahabad, Jhalwa, Allahabad- 211012, Uttar Pradesh. </strong></li>
<li> Applicants are advised to keep visiting the Science Conclave website for screened candidate list.</li>
<li> Participants will have to bear their travel expenses. Institute would take care of hospitality.<strong></strong></li>
</ul></td>
</tr>
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<td valign="middle" ><table width="5%" border="0" align="center" cellpadding="3" cellspacing="3">
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<td valign="top"><?php if($recordId) {?><input type="button" value="Print this page" onclick="window.print();"><input type="hidden" name="recordId" value="<?php echo $recordId;?>" /><?php } ?></td>
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