REGISTRATION FORM – A

REGISTRATION FORM – A

21^st NATIONAL CHILDREN SCIENCE CONGRESS - 2013

DISTRICT:                                                                                                                                        STATE:  GUJARAT

PARTICULARS OF TEAM LEADER:

1. NAME OF GROUP LEADER:_______________________________________________

2. DATE OF BIRTH: ________________________________________________

3. STD / CLASS: __________________________ ,   

4. SEX: ________________________,   
5. RURAL / URBAN: ____

6. RESIDENTIAL ADDRESS:  ________________________________________________________________________________                                            ________________________________________________________________________________________________

                                                                                                          PIN CODE:  _________

7. E-MAIL:   ___________________________________  TEL/MOBILE NO: ____________

8. NAME & ADDRESS OF SCHOOL / INSTITUTE ___________________________________                                                          _______________________________________________________________________________

  _____________________________________________________ PIN CODE:  _______________

9. E-MAIL:   ____________________________                      TEL/MOBILE NO: ____________

10. NAME OF  PRINCIPAL: ____________________________________________________

11. RESIDENTIAL ADDRESS:  ___________________________________________________

                                                   ______________________________________________________

 ____________________________________________________________________  PIN CODE:  _______________

12. E-MAIL:   _______________________________________  TEL/MOBILE NO: __________

13. TITLE OF THE PROJECT: __________________________________________________________________________

14. UNDER THE SUB THEME: __________________________________________________________________________

15. LANGUAGE USED : _____________________________________________________________________________

16. NAME & ADDRESS OF GUIDE TEACHER: _________________________________________________________________________________

                                                                            _______________________________________________________________________________                                                                           ______________________________________________________  PIN CODE:  _______________

17. E-MAIL:   ______________________________           TEL/MOBILE NO: ______________________________

PARTICULARS OF OTHER TEAM MEMBERS:

SR	NAME	ADDRESS	SEX	STD.	BIRTH DATE
1
2
3
4

_____________________________                                                          _____________________

    SIGNATURE OF DISTRICT CO ORDINATOR                                                         SIGNATURE OF         

                                                                                                                      PRINCIPAL WITH SEAL