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Registration Form - State Level Workshop "India on the Move"
State Level Workshop “India on the Move” Under QIP of Savitribai Phule Pune University - 8th & 9th February, 2019
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Name of the Participant :
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Your answer
Institute / Organization:
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Your answer
Designation:
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Your answer
Category: (for Further details visit on :
http://moonjeinstitute.com
)
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Corporate
Faculty Member
Research Scholar
Student
Address for correspondence
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Mobile No:
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Phone (with STD Code):
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E-mail Id:
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Your answer
Participating in Innovative Start up Ideas Competition (For students)
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Yes
No
Details of Fees Payment (Select preferred mode)
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D. D. / at par cheque drawn in favour of "Director, Dr. Moonje Institute" payable at Nashik
Direct Deposit in Bank of Baroda, Gangapur road, Nashik (M.S.) in the Account Number: 27850100002312, IFSC code: BARB0GANNAS (5th character is Zero)
Cash
Detail : Demand Draft/Cheque No/Transaction No
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Name Of Bank
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Amount
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