ONLINE REGISTRATION FORM
Course :    [/Engg/Class/] Admission Test For One Year Weekend Course for Medical Ent. Exams 2009
Price    :    400/- (without relevant scholarships if any)
Personal Information  
  Name of the Candidate    
  Father’s / Guardian’s Name    
Contact Information  
 

Correspondence Address
State
Pin
Ph. (Res.)(with STD code)
Mobile No.
Permanent Address
same as correspondence address
State
Pin
Ph. (Res.)
E-mail ID of the Student
Additional Information

Mode of Payment Demand Draft Online Bank Transfer Credit Card
 
Payment Plan
Full
 
Pricing Options
Full Fee
 
I agree to the Terms and conditions.
 
** All the Terms and Conditions for this course are detailed in the course Prospectus.

Please note that all scholarship concessions will be confirmed only on receipt of the attested marksheet from the student and if the marks do not justify the concession, the differential payment will need to be made before the enrolment can be finalized