ICVGIP 2004

				Application for fellowship
Name: 

+Title/Position: 

E-mail: 

Affiliation: 

Accepted ICVGIP 2004 Paper (if any)

	Number:

	Title:


Are any of the coauthors, (if any) attending the conference? 

Support for
Full Registration:		Yes/No	Amount: Rs.
Partial Registration:		Yes/No	Amount: Rs.
*Travel:			Yes/No	Amount: Rs.
Local Hospitality:		Yes/No

Other sources of support for travel and amount of support:



Briefly justify your request for the fellowship.






Please send your to the following address:
Convener, 
Organizing Committee ICVGIP 2004
ECSU
Indian Statistical Institute
203 B. T. Road
Kolkata 700108
e-mail: dipti@isical.ac.in
Fax: +91 33 25783357, +91 33 25773035, +91 33 25776680.
________________________________________________________________________________
+For students, the application must include a certificate from the Head of the Department.
*Photocopy of Ticket along with the original must be produced at the time of reimbursement.