REGISTRATION FORM - PART A

ADMISSION TICKET
To be kept by the participants and produced at the time of examination
Name of the participant :…............................................................... Age/sex:.....................................
Name of the school :......................................................................... Class/section:......................
S/o / D/o :..................................................................................... Contact no: .:....................................
Contact address:.........................................................................................................................................
Paid the sum of rupees (Rs) =.................... Participant’s sign=...............................................
(

)

(

Coordinator’s Sign

)
Signature & stamp of the
Head of the institution

# The cost of individual form is Rs 100/- The last date of submission of the form is 22/07/2013 in
respective schools and 25/07/2013 in other counters.
SPOT REGISTRATION = Rs 500/# These forms will be available in the respective schools, Gahtori Hospital, Kasturi Devi Hospital
and Dr K.K Aggarwal Hospital Bazpur road.
# The PART -A form has to be preserved and produced at the time of First round as admission
ticket.
PART -B will be kept by school authority and send to the quiz organisers for cross checking.
# Don’t forget to ask about the topic, rules and format of the quiz from the school coordinator.
# For any query please take help from your school coordinator else contact =Dr Bharti Gahtori
(9837259947), Dr Rajat Gupta (9837064797), Dr K K Aggarwal (9837020014)
______________________________________________________________________________________________
XE
XEROX COPY ACCEPTED
CC>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
______________________________________________________________________________________________

PART - B
TO BE PRESERVED BY THE QUIZ COORDINATOR FOR AUTHENTICATION
Na
Name of the participant :…....................................................................Age/sex:................................
Na
Name of the school :.............................................................................Class/section:......................
Fath Father’s/Mother’s name :.............................................................. Contact no: .:...............................
Con Contact address:.....................................................................................................................................

..............................................................................................................................................................
Pa
Received the sum of rupees (Rs) =......................
Participant’s sign............................................

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