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<title>--7th Science Conclave --</title>
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<body >
<table width="100%" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" > </td>
<td valign="top"><form name="userFrm" action="" method="post" onsubmit="return validateUser(this);">
<table width="100%" height="100%" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" > </td>
<td valign="top"><?php
$i=1;
if(!empty($userDetails))
{
foreach($userDetails as $key=>$value)
{
//print_r($value);
?><table width="100%" height="99%" cellpadding="0" cellspacing="0">
<tr align="center">
<td colspan="3" ><table width="100%" border="0">
<tr>
<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>
<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 $value['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>
<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 $value['firstName'];?> </td>
<td width="9%"><strong>Age :</strong></td>
<td width="34%"> <?php echo $value['age'];?></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td width="10%" align="left" ><strong>Gender :</strong></td>
<td width="19%" ><?php if($value['gender']==0){?>
Male
<?php }?>
<?php if($value['gender']==1){?>
Female
<?php } if($value['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 $value['nameOfUniver']?></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td><strong>Address for Correspondence :</strong>
<?php echo str_replace("\n","<br />",$value['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 $value['mobile']?></td>
<td width="11%" align="left" ><strong> E-mail :</strong><strong></strong></td>
<td width="60%" align="left" ><?php if($value['email']){echo $value['email'];} else {echo "N/A";}?></td>
</tr>
</table></td>
</tr>
<tr>
<td colspan="2" align="left" ><table width="95%" border="0" align="center">
<tr>
<td><strong>Emergency Contact :</strong>
<table width="100%" border="0">
<tr>
<td width="8%"><strong>Name </strong></td>
<td width="31%"><?php if($value['emergencyName']){echo $value['emergencyName'];} else {echo "N/A";}?></td>
<td width="11%"><strong>Relationship</strong></td>
<td width="50%"><?php if($value['emergencyRelation']){echo $value['emergencyRelation'];} else {echo "N/A";}?></td>
</tr>
</table>
<table width="100%" border="0">
<tr>
<td width="8%"><strong>Mobile</strong></td>
<td width="25%"><?php if($value['emergencyMobile']){echo $value['emergencyMobile'];} else {echo "N/A";}?></td>
<td width="8%"><strong>Email</strong></td>
<td width="26%"><?php if($value['emergencyEmail']){echo $value['emergencyEmail'];} else {echo "N/A";}?></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
<tr>
<td align="left" > <strong>Applicant Status : </strong></td>
<td align="left" ><?php if($value['participantStatus']==2){ echo "Teacher";} else if ($value['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 $value['areaOfInterest'] ?> </td>
<td width="12%" align="left" bgcolor="#FFFFFF"></td>
</tr>
<tr >
<td colspan="3" ><strong> ACADEMIC RECORD </strong></td>
</tr>
<?php if($value['participantStatus']==0||$value['participantStatus']==1){ ?>
<tr>
<td colspan="3" align="left" <?php if($value['participantStatus']==0 ||$value['participantStatus']==1){ ?>class="thickb" <?php }?>><table width="100%" border="0" >
<tr>
<td width="100%"><strong> Records of Last Exams Passed:</strong>
<table width="100%" border="1">
<tr>
<td width="33%" valign="top"><strong> Name of Exam </strong></td>
<td width="32%" valign="top"><strong> University / Board </strong></td>
<td width="35%" valign="top"><strong> Rank in Class</strong></td>
</tr>
<?php if($value['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 $value['division1']?></td>
</tr><?php }?>
<?php if($value['participantStatus']==1){?> <tr>
<td><strong>M.Sc/M.A. Final Year(for Phd students only)</strong></td>
<td><?php echo $value['university2']?></td>
<td><?php echo $value['division2']?></td>
</tr>
</table></td>
</tr><?php }?>
</table></td>
</tr>
<?php }?>
<?php if($value['participantStatus']==2){ ?>
<tr>
<td colspan="3" align="left" valign="top"<?php if($value['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 $value['yearinTeaching']?></td>
<td width="17%"> <strong>No. of publications : </strong></td>
<td width="30%"><?php echo $value['noOfPubJournals']?></td>
</tr>
</table></td>
</tr>
<tr>
<td> </td>
</tr>
</table>
</td>
</tr>
<?php }?>
<?php if($value['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>
</table></td>
</table><P STYLE='page-break-after: always;'></P>
<?php $i++; } } else {?></td><td valign="top" > </td>
</tr>
<tr class="<?php echo $rowClass;?>">
<td align="center" valign="middle" colspan="12" class="error">Sorry,No Record found.</td>
</tr>
<?php }?>
<tr>
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