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APPLICATION FORM

 ( * ) Mandatory Information.
 
For admission to :
Name * :
Address * :
Telephone No. *:
(Format:9101126420618)
Qualifications :
Profession :
Purpose of Learning :
Previous Knowledge :
Date of Birth *:
(Format: dd/mm/yy)
Time of Birth * :
(Format: hh:mm:ss am/pm)
Place of Birth :

Mode of payment * :   

Rs.  or  US$ as per      
PAYMENT PROCEDURE.
Your E-mail * :

Pls send the above information through a separate e-mail to :  dr_asethi@yahoo.co.uk