CETPA INFOTECH PVT. LTD.

(An ISO 9001:2000 Certified Company)

Registration Form

Name:

Fathers Name:

Nationality: INDIAN NRI FOREIGNER Gender: Male Female Paste your

Permanent Photo Here
Address:

Email ID:

Alternative
Email ID:
Mobile Ph. No.
No.

Working Status: Student Employed

Branch: Organization Name: ________________________

College Year: Sem:

College Name:

College City: State:

Training Location: Roorkee Greater Noida Lucknow Other____________________

Course to be .NET J2EE C & C++ Embedded System

Joined: AutoCAD VHDL CATIA Others (Specify) ___________

Batch Date: ____________________ Duration: _______________

Food and Lodging: (If required)
Student Sign:
For office use only:-
Course Fee: _____________ Enrollment No: __________

Sr. Fee Details Amount Cash/DD Date DD Details Receiver Sign

No.
1. Reg. Fee
2. Course Fee
3.
4.
Total

Food & Lodging Fee: ________________

Sr. Fee Details Amount Cash/DD Date DD Details Receiver Sign
No.
1. Reg. Fee
2. F & L Fee
Total

Signature
Account Officer
(With Seal)