REGISTRATION FORM

APPLICANT INFORMATION
Name:
Date of birth:
Current address:
City:
Parents Mobile No. :

Mobile No :

Email :

State:

ZIP Code:

Parents Email :
EDUCATIONAL INFORMATION

Current Institute/College:
Institute address:
Course :
City:

Average Percentage(Till Today) :

State:

Previous Institute/College:
Institute Address:
Course
Average Percentage :
City:
State:
COURSE PREFERNCE

ZIP Code:

ZIP Code:

Course Name :

Year of Attempt:

Date of Starting:

Course Name :

Year of Attempt:

Date of Starting:

Signature of applicant

Date:

*Terms and Conditions Apply

Cancellations/Changes and Refunds:
Conference registration fee is non-refundable and nontransferable.
Substitutions are allowed at no charge. Organizers reserve the right to accept or reject registration
request. Your Registration is deemed confi rmed only after you receive a conformational e-mail/SMS.
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Student Receipt
Date: _________________
Student Name: ______________

__________________

__________________

Amount Received: ____________ In words: _________________________ for the course_________

Authority Signature

CompetitiveZone

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CompetitiveZone, Ghat Road, Near SD Hospital Nagpur-09

+917841960058
www.competitivezone.in