Registration Form

For smooth experience, Please use updated Google Chrome browser to fill this form.

1) Surname: *

Please enter a valid surname

Name: *

Please enter a valid first name

Father's Name: *

2) Mobile No: *

You may get a SMS on this number after payment

Please enter a valid mobile number

Email address: *

Please enter a valid email id

Username/roll number: *

Please enter a username or roll number provided by institute. This will be used for login

Enter a password: *

Please enter a password

3) Gender: *

Male Female

Please select a gender

4) Courses available: *

Please select atleast one package

7) Date of Birth: (DD-MM-YYYY) *

Please select a valid Date of birth

You need to pay : {{getPrice()}} /-

* marked fields are mandatory/compulsory

Terms and conditions:
There will be no refund of the fee once you have successfully made the fee payment and are registered

Please make sure you have entered your correct personal information.

I accept the above instructions

Please accept the terms and conditions

Please fill all the required fields

By clicking "Submit" you agree to the terms and conditions above.

For technical queries only regarding form, Call: 9834274471 (11am - 6pm)