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Registration Form 2016

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Registration Form 2016

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NATIONAL CONFERENCE

on
AFFIRMATIVE ACTION AND THE INDIAN CONSTITUTION
JANUARY 8-9, 2016.
REGISTRATION FORM
(Fill in Capital Letters)
Name of the Participant Ms/Mr: ______________________________________________
Postal Address: _____________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Name of Representing Institution ______________________________________________
___________________________________________________________________________
Professional Position/ Student: ________________________________________________
Email: ___________________________________ Mobile Number: __________________
Payment Details
Amount (in words): _________________________________________________________
DD No: __________________________________Date: _____________________________
Drawn on:__________________________________________________________________
Signature and Date:

Stamp/ Seal of Institution Head/


Head of Department

____________________________

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