Course
Chosen
(Use Ctrl key to select more than one option) |
|
Title
|
Mr
Mrs
Ms
|
Name |
|
Address
For Communication |
|
Pincode |
|
Phone |
|
E-mail:
(if available) |
|
Date
of Birth (as given in high school certificate) |
|
Educational Qualification (1) |
|
Educational Qualification (2) |
|
Educational Qualification (3) |
|
Whether
Employed |
Yes
No |
Mode
of Exam Postal |
Postal
Lucknow Centre |
State
whether NRI / foreign Student |
Yes
No |
Do
you want Study Material to be sent by Registered
Post (if yes then add required postal Charges in fee) |
Yes
No |
Do
you want to do the course in FAST
TRACK SYSTEM (if yes then add required Charges in fee) |
Yes
No |
Mode
of payment |
|
Payment
Details |
Cash |
Rs |
|
|
|
|
Draft |
No. |
|
Date |
|
|
Bank
|
|
Amount |
|
|
|
|
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