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  • SUPRA Event Registration 2016 Form

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    Anantbhushan Navelkar
    227 views6 pages
    The document appears to be a registration form for Team Pacers Racing to participate in SUPRA SAEINDIA 2016. It includes details about the team such as team name, captain contact information, college/institution details, and a list of 25 team members along with their contact and role information. It also includes payment details such as a demand draft number, amount, and instructions to send the form and payment by post to the SUPRA SAEINDIA head office in Chennai.

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    The document appears to be a registration form for Team Pacers Racing to participate in SUPRA SAEINDIA 2016. It includes details about the team such as team name, captain contact information, college/institution details, and a list of 25 team members along with their contact and role information. It also includes payment details such as a demand draft number, amount, and instructions to send the form and payment by post to the SUPRA SAEINDIA head office in Chennai.

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    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
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    227 views6 pages

    SUPRA Event Registration 2016 Form

    Uploaded by

    Anantbhushan Navelkar
    The document appears to be a registration form for Team Pacers Racing to participate in SUPRA SAEINDIA 2016. It includes details about the team such as team name, captain contact information, college/institution details, and a list of 25 team members along with their contact and role information. It also includes payment details such as a demand draft number, amount, and instructions to send the form and payment by post to the SUPRA SAEINDIA head office in Chennai.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xls, pdf, or txt
    of 6

    SUPRA SAEINDIA 2016 - Registration Form

    TEAM DETAILS
    * Team Name
    * Name of the Captain
    * Contact Email Id.
    * Phone No.
    Department / Class

    TEAM PACERS RACING


    ANANTBHUSHAN NAVELKAR

    abdnavelkar@gmail.com
    9049350755
    Mechanical / Third Year

    H. No.:- E-89, Near Maruti Temple, Marutigad, Mala, Panaji-Goa


    403001

    * Postal Address

    COLLEGE / INSTITUTION DETAILS


    * College Name
    * Faculty Advisor
    * Contact Email Id.
    * Phone No.
    Department & Designation
    2nd Faculty Advisor
    2nd Contact Email Id.
    2nd Phone No.
    Department & Designation

    * Postal Address

    Padre Conceicao College of Engineering


    Prof. Flasio Colaco

    flasio.tc@gmail.com
    8806829151
    Mechanical (Asst. Prof.- Contract)
    Prof. Dattaprakash Vernekar

    dattaprakash_vernekar@yahoo.com
    9004015150
    Mechanical (Asst. Prof.- Contract)

    Padre Conceiao College of Engineering,


    Agnel Technical Education Complex,
    Agnelganv,
    Verna Goa, 403722

    Name of the sponsor (if any)

    SAEINDIA ACTIVITIES
    * SAEINDIA Collegiate Club details
    * Date of SAEINDIA Collegiate Club formation
    *SAEINDIA Collegiate Club Bank A/c TitleName.

    PCCE SAE COLLEGIATE CLUB


    2/5/2014
    MR JOE KURIAN
    ###

    *Bank Account Number


    *Bank Name
    *Bank Branch

    *Bank Address

    *Bank IFSC code

    PUNJAB NATIONAL BANK


    VERNA (GOA)

    SHOP NO. 1, 2, 3 ESPLRNR, CURCOLEM, SALCETTE, VERNA(PHONE 9422440470)

    PUNB590900

    PAYMENT DETAILS
    * Demand Draft No.

    524417

    * Demand Draft Date

    5/2/2016

    * DD Amount
    * Issue-Bank Name/Place

    40075
    THE FEDERAL BANK LTD. / PANAJI

    DD in the Name of "SUPRA SAEINDIA".


    Payable at chennai

    TEAM NAME: TEAM PACERS RACING


    Sl.no
    1

    Team Members
    Anantbhushan D. Navelkar

    2
    3

    Dheep Caldeira

    4
    5

    Ankit Naik

    Saideep Sopte
    Anshul Mahale

    6
    7

    Anthony Lopes

    8
    9

    Stephan Texeira

    Anish Naik
    Aniket Chodankar

    10
    11

    Keegan Pereira

    12
    13

    Anup Shetty

    14
    15
    16
    17
    18
    19
    20
    21
    22

    Noah Pereira
    Aishwarya KC
    Adrin Travasso
    Varun Mandrekar
    Amey Mayanath
    Vihar Revankar
    Aayesh Tari
    Wilbur Pereira
    Plinius Aditya Dacosta
    Anchit Sharma
    Rufus Fernandes

    23
    24

    Shubham Shet

    25

    Myron Chico

    Hafiz Khan

    Email Id

    abdnavelkar@gmail.com
    dheep_caldeira@hotmail.com
    sopte.saideep@gmail.com
    ankitnaik05@gmail.com
    anshulmahale1@gmail.com
    13thanthony@gmail.com
    anishnaik111@gmail.com
    stephentexeira@ymail.com
    chodankar.aniket@gmail.com
    keeganpereira35@gmail.com
    noah.177@hotmail.com
    anup0304@gmail.com
    aishu3295anu@gmail.com
    adrin.travasso@yahoo.in
    varunmandrekar38@gmail.com
    hi.amey007@gmail.com
    vihar2503@gmail.com
    aayeshtari03@gmail.com
    wilbur.xavier@gmail.com
    adityadacosta777@gmail.com
    anchit9999@gmail.com
    rufusfernandes95@gmail.com
    shubhamshet394@gmail.com
    shabazkhanpathan32@gmail.com
    myronchico27@gmail.com

    Mobile No.
    9049350755

    SAEINDIA + 1Membership No.


    7150527530

    Responsibility
    Captain

    9975771511
    9405222596

    7140522391
    7150527518

    Vice-Captain
    Suspension

    9503394386
    8378002274

    7150527529
    7150527525

    Steering
    Engine

    7507189339
    9168119346

    7150527524
    7150527528

    Transmission
    Braking

    8308326895
    9923441231

    7150527543
    7150527519

    Steering
    Engine

    7507647963
    9527178861

    7150527532
    7150527533

    Sponsorship
    Finance

    8698811201
    8806221546

    7150527539
    7150527523

    Marketing
    Electronics

    9922954269
    8806851632
    9822183766

    7150527544
    7150527526
    7150527527

    Finance
    Steering
    Suspension

    9881058359
    8796900548

    7150527536
    7150527542

    Suspension
    Engine

    9823684216
    8275439153

    7150527534
    7150527520

    Chassis
    Transmission

    8806750652
    9011947839

    7150527537
    7150527522

    Transmission
    Chassis

    9011480586
    8007647454

    7150527538
    7150527553

    Braking
    Chassis

    9765953767

    7150527559

    Sponsorship

    Hard copy of this Excel sheet Along with DD/Cheque of amount Rs. 40075 (35000+14.50% service tax) In favour of SUPRA SAEINDIA can be sent by post to- Mr. Bibhu Kumar, Saeindia head office: 1/17,Ceebros Arcade, 2nd Floor, 3rd Cross,
    kasturba Nagar, Adyar. Chennai - 600020. Contact No.+91 8870471510 | suprasaeindia@saeindia.org

    T-shirt size
    L
    XL
    L
    M
    XL
    L
    M
    L
    L
    L
    L
    XL
    L
    XXL
    L
    L
    L
    L
    L
    XL
    XL
    XL
    XL
    L
    L

    ffice: 1/17,Ceebros Arcade, 2nd Floor, 3rd Cross,

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