Registration Form

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Dec 23, 2017 - PANDIT MADAN MOHAN MALAVIYA NATIONAL MISSION ON TEACHERS AND TEACHING (PMMMNMTT). Faculty Development Centre.
PANDIT MADAN MOHAN MALAVIYA NATIONAL MISSION ON TEACHERS AND TEACHING (PMMMNMTT) Faculty Development Centre Banasthali University P.O. Banasthali Vidyapith, Rajasthan – 304022 Web: www.banasthali.org

Registration Form Theme:

Soft Computing Techniques and Applications (SCoTA - 17)

Duration:

23 December 2017 to 28th December 2017

Photograph

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01. Name of applicant with qualification: ___________________________________ _____________ (In CAPITAL letters) First Middle Last Qualification 02. State whether you need accommodation? (Limited accommodation available) Yes No 03. Address for Correspondence (A) College____________________________ (B) Residence__________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ Pin____________State_______________ Pin____________State_______________ 4. Phone No.: (STD Code)_______________ (O)_______________ (R)_____________ (F)_________ (Mobile)___________________________ (Email) Compulsory ____________________________ 05. Sex: Male

Female

06. Category:

SC

ST

OBC

General

07. Date of Birth(DD/MM/YY) : __________________ 08. Designation : _______________ 09. Subject: _____________ 10. Department: ______________ 11. Institution name: ___________________________________________________________________ ______________________________________________________________Type: ______________ Y M

12. Total teaching experience: Total

Y M U.G.

Y M P.G.

13. Any chronic medical problem? (please state):____________________________________________

I certify that the above information and particulars are correct to the best of my knowledge. I hereby undertake to participate in the course, do the assignment work during the course and to abide by the rules and regulation of University and UGC. Date: Place:

Signature of the Applicant

Recommendation of the forwarding authority

I certify that our college is affiliated to the University of ______________________________________. He / She is a faculty of this university /college and further recommends that if the candidate is selected for the course, he/she will be relieved. Date: Place:

Signature

Office Seal