Student Registration Form

PERSONAL INFORMATION

Your Name

Mobile No.

Date of Birth

Affix Photograph (Instructions: Less than 1MB size is valid)

Permanent Address

Area of Interest

Country

Gender
 Female Male Other

Mobile No. (Alt.)

Email id

Current Address

City

State

Pincode

ACADEMIC/PROFESSIONAL INFORMATION

Batch (Passing year)

RGUHS Reg. No

IF WORKING

Name of Firm/Company

Designation

COA Reg. No

IF STUDYING

Name of University

Program

Year of Graduation