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B-Tech / MCA / MSc - 2007 Registration Form

Please complete the registration and submit your resume in one sitting. All fields marked *are mandatory
Personal Details
First Name * :
	Required: Field cannot be blank Please enter valid Name
Last Name * :
	Required: Field cannot be blank Please enter valid Name
Email Address * :
	Required: Field cannot be blank Please enter valid Email
Secondary Email* :
	Required: Field cannot be blank Please enter valid Email
Please provide frequently used e-mail address as these will be used to contact you in future
Date of Birth:
	Please select Date of Birth
Gender
	Please select Gender
Marital Status
	Please select Marital Status
Present Address		Permanent Address
Address * :		Address * :
	Required: Field cannot be blank		Required: Field cannot be blank
State * :		State * :
	Please select state		Please select state
City *:		City *:
	Required: Field cannot be blank Please enter valid city		Required: Field cannot be blank Please enter valid city
District * :		District * :
	Please select district		Please select district
If others :		If others :
	Required: Field cannot be blank Please enter valid city		Required: Field cannot be blank Please enter valid city
Pin Code * :		Pin Code * :
	Required: Field cannot be blank Please enter valid pincode(must be 6 digits)		Required: Field cannot be blank Please enter valid pincode(must be 6 digits)
Contact Telephone Number*
Contact No :	Code:	Phone Number :
	Required: Field cannot be blank Please enter valid area code(must be 4 digits)		Required: Field cannot be blank Please enter valid phone No.(must be 7 digits)
Mobile No :
	Required: Field cannot be blank Please enter valid Mobile No.(must be 10-12 digits)
Additional Information
Languages known * :	Read	Write	Speak

Required: You should know atleast one language Please enter valid language


Passport No :
Education
Secondary (%) :		Higher Secondary (%) :
	Please select percentage		Please select percentage

Qualification :		If others
	Please select Graduation
			Required:Field cannot be blank Please enter valid qualification
Area of Specialization :
	Please select area of specialisation
Board / University :		College :
	Required: Field cannot be blank Please enter valid university name		Required: Field cannot be blank Please enter valid college name
Aggregate : %

	Please select aggregate %
Post Qualification :		If others
	Please select post graduation
			Required:Field cannot be blank Please enter valid qualification
Area of Specialization :
	Please select area of specialisation
Board / University :		College :
	Required: Field cannot be blank Please enter valid university name		Required: Field cannot be blank Please enter valid college name
Aggregate : %
	Please select aggregate %

Gap in Academics (in yrs) * :		No of current backlogs * :
	Required: Field cannot be blank Please enter Academic gap in digits		Required: Field cannot be blank Please enter current backlogs in digits