Chemolympics 2023 Registration

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Google Forms <forms-receipts-noreply@google.com> Tue, 31 Oct, 2023 at 6:25 pm

To: 44jyotirmoy@gmail.com

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Chemolympics 2023 Registration

Please fill this form carefully. Only one response per candidate is allowed.
Registration fee (Rs. 100/-) to be paid online to A/C No. 10243129514. A/C Name:
Society for Chemical Education, Assam. IFSC: SBIN0002060. Please note the online
transaction/receipt number and date.
Compulsory: Please take a print-out of the filled form and submit to the respective
Centre-incharge before 03/11/2023 (2PM).

Your email (44jyotirmoy@gmail.com) was recorded when you submitted this form.

Name of Examination Centre *

DK College, Mirza

Name of Candidate *

Jyotirmoy Das

Email *
 44jyotirmoy@gmail.com

Contact Number of Candidate *

6003622436

Name of the student's Institute/School/College *

Dakshin Kamrup college,mirza

Class *

XI

Online Payment Receipt/Transaction Number *

367020761061

Payment Date *

MM DD YYYY

10 / 31 / 2023

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