Online Registration

Camp Registration

Registering For:

Basic Course Residential (Marathi)
Date : 16 th March 2020 to 20 th March 2020

Personal Details :

* First Name :

* Last Name :

* Gender :

* Date Of Birth :

Phone :

* Mobile :

* Email :

* Education :

Talents :

Pan No :

* Address :

* City :

* Pincode :

* State :

* Country :

Company Details :

Company :

Phone 1 :

Phone 2 :

Email :

Pincode :

City :

State :

Country :

Address :

Occupation :

Business      Professional      Service      Housewife      Retired/VRS      Student     

* Condition of Health :

Good Health     
Asthma     
Constipation     
Heart Trouble     
Mental Disorders     
Acidity/Gases     
Cold     
Insomnia     
Back Ache     
Anaemia     
Diabetes     
Cough     
Blood Pressure - High     
Blood Pressure - Low     
Arthritis/Rheumatism     
Any Other (please specify below)     

How did you come to know about us?

Banner/Board/ Hoarding     
Newspaper Advertisement     
Magazine Advertisement     
Railway Advertisement     
Newspaper Article     
Magazine Article     
SMS Campaign     
Radio     
T.V.     
Internet     
Pamphlet     
Friend/Relative     

Attach Photo

(Max size allowed - 200 KB; preferably passport size – about 2 inches x 2 inches.)

* For verification, type the number from the image in textbox below: captcha