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ICROM WORKSHOP REGISTRATION FORM

Tehran, Sharif University of Technology, Feb. 2013


Deadline of Registration 9th of February 2013

Please complete and return by e-mail to workshop@icrom.ir.


Please note that the name and title you give here will be printed on your badge and the participants list.

Date:
Venue:

15th February, 2013


Sharif University of Technology, Tehran

1. Workshop Title
Workshop title: Autonomous Mobile Robots: Past, Present and Future of SLAM and

Mechatronics Knowladge Usage in HVAC Designing


A list of workshop titles is available at http://icrom.sharif.ir/cnf/workshop.

2. Participant Information
Family name: Tafrishi
First name: Seyed Amir
Title:_______ Prof. Dr. other:_________________________ Mr. Ms. Mrs.
Affiliation: Islamic Azad University Of Tabriz
Latest degree or current academic program: Undergraduate Student of Electrical Enigneering
Address: No96, Front of Salman Bagal, Naqafi Alley, Talegani Street, Tabriz, Iran
Postal/Zip code: 5138877977 City: Tabriz
Country: Iran
Telephone: 00984115403822, 00989143092163
Fax: E-mail: amirtafrishi@yahoo.com

3. Workshop Fee
Workshop fees include admission to workshop, materials and tea/coffee break on February
15th 2013.

Recipient of Late Prof. Lucas & Prof.


Tahani Grant (students)
Recipient of Late Prof. Lucas & Prof.
Tahani Grant (non-students)
Non Members
Society student Members
Society non-student Members (IEEE,

Registration
Fee (Rials)
400,000
1,000,000
2,000,000
1,600,000
1,200,000

Description
For those students who have obtained the grant. See
http//icrom.ir for more information
For those non-students who have obtained the grant.
See http//icrom.ir for more information
IEEE, Robotics Society of Iran, Iranian Society of
Mechatronics
IEEE, Robotics Society of Iran, Iranian Society of

Robotics Society of Iran, Iranian Society


of Mechatronics)

Mechatronics

*Please include a copy of your valid student card/other formal identification.

Deadline for registration: 9th February 2013

4. Payment
Payment information:
Acc No:
611648277
Branch:
Keshavarzi Bank-K.N.Toosi University of Technology 1103
Branch code:
4919
Shaba:
IR59 0160 0000 0000 0611 6482 77
Account name: Robotics Society of Iran
** Please state the workshop name and the full name of the participant on the reverse of the bank note.

5. Additional Notes
Important Note: The workshops having less than 10 registered participants will not be
held. The registrations fees will be refunded.
Deadlines: Prepaid Advanced Registration must be electronically submitted no later than 9th
of February 2013. If you should have problems registering, please contact (info@icrom.ir).
Payment Information: Registration forms must be accompanied by full payment in order to
be processed.
Confirmation: Please allow 3 days for e-mailed confirmation of your registration.
By sending in this registration form, I acknowledge that I commit myself to the immediate payment of
the full workshop fee. I have taken notice of the cancellation terms on this form.

Date: 03/Feb/2013

Signature:
Return address: No96, Front of Salman Bagal, Naqafi Alley, Talegani Street, Tabriz , Iran
Email: workshop@icrom.ir.
Website: http://icrom.sharif.ir/cnf/workshop

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