REGISTRATION FORM

APPLICANT INFORMATION

Name:

Date of birth: Mobile No : Email :

Current address:

City: State: ZIP Code:

Parent’s Mobile No. : Parent’s Email :

EDUCATIONAL INFORMATION

Current Institute/College:

Institute address:

Course : Average Percentage(Till Today) :

City: State: ZIP Code:

Previous Institute/College:

Institute Address:

Course Average Percentage :

City: State: ZIP Code:

COURSE PREFERNCE

Course Name : Year of Attempt: Date of Starting:

Course Name : Year of Attempt: Date of Starting:

Signature of applicant Date:

*Terms and Conditions ApplyCancellations/Changes and Refunds: Conference registration fee is non-refundable and non-

transferable. Substitutions are allowed at no charge. Organizers reserve the right to accept or reject registration request. Your Registration is deemed confirmed 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_________

CompetitiveZone Authority Signature

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CompetitiveZone, Ghat Road, Near SD Hospital Nagpur-09+917841960058

www.competitivezone.in