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NATIONAL WORKSHOP

ON
ACCELEROBOTICS
Registration Form
Name: ________________________________________________
Date of Birth : __________________________________________
Branch: ________________________________________________
Name of the Institution: ___________________________________
_________________________________________________________

Mailing Address:
_______________________________________________________________________
_______________________________________________________________________

Contact No: _________________________ E-mail: _____________________________

Reg. No :
(allotted by Dept.)

Signature of the participant

ACKNOWLEDGEMENT

We hereby acknowledge the receiving the Registration Mr/Ms_______________________


__________________ and paid the fees of Rs.1200.00.

Date of Receiving :

Sign. of Receiver

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