Online-Form

STUDENT REGISTRATION FORM

FIRST NAME	(max 30 characters a-z and A-Z)
LAST NAME	(max 30 characters a-z and A-Z)
DATE OF BIRTH	Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year: 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980
EMAIL ID
MOBILE NUMBER	(10 digit number)
GENDER	Male Female Others
ADDRESS
CITY	(max 30 characters a-z and A-Z)
PIN CODE	(6 digit number)
STATE	(max 30 characters a-z and A-Z)
COUNTRY
HOBBIES	Drawing Singing Dancing Sketching Others
QUALIFICATION	S.N School Name Of School Percentage Year of Passing 1 Send-up/S.E.E 2 Class XII 3 Graduation 4 Masters (10 char max) (upto 2 decimal)
COURSES APPLIED FOR	MBBS B.Pharmacy BDS Bsc. Nursing