2018 MINNESOTA POWER SYSTEMS CONFERENCE

Saint Paul RiverCentre

Saint Paul, Minnesota

STUDENT REGISTRATION FORM

Name Raghavendra Mahabalagiri Bhat

Address #425, 13th Avenue, South East , Apt no 402

City Minneapolis State MN Zip code 55414

E-mail bhatx075@umn.edu

Institution College of Science and Engineering, University of Minnesota, Twin Cities

Telephone 612-404-6850 Fax ---

STUDENT REGISTRATION FEE (CF0749)

____ Enclosed is $25

STUDENT FEES STATEMENT

____ Enclosed is a copy of my current student fees statement.

METHOD OF PAYMENT
____ Enclosed is a check or money order payable to the University of Minnesota.
✔ Charge my credit card (Please circle one):
____
✔
VISA MasterCard Discover/Novus American Express
6011 0060 7761 7877
Card Number
Expiration Date 01/23

Amount to Charge $ 25

Name as printed on card (please print) Raghavendra M. Bhat

Signature of card holder

PLEASE SEND REGISTRATION, PAYMENT, AND CURRENT FEES LIST TO:

CCAPS Registration Center, University of Minnesota,

353 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN 55108-6039
or Fax: 612-624-5359