REGISTRATION FORM
                                                   TEACHER PARENT EMPOWERMENT PROGRAM
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                                         KOTHARI STARZ- EMPOWERING THE LEARNERS!
APPLICANT'S FULL NAME *
GENDER *
APPLICANT'S ADDRESS *
CITY *
STATE *
APPLICANT'S AGE *
APPLICANT'S CONTACT NO. *
APPLICANT'S E-MAIL ID *
LAST QUALIFICATION *
JOB DETAILS *
CURRENT DESIGNATION
LIST OF TRAINING(Choose Any1/Any 5/ All *
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COURSE OPTED FOR *
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DISCLAIMER :                                                                                    A. ALL ABOVE INFORMATION IS TRUE AND BEST OF MY KNOWLEDGE                                                                                         B. REGISTRATION AMOUNT OF RS.100/-(ONE TIME) TO BE PAID ALONG WITH THE MODULE FEES.EACH TRAINING FEES IS RS.400.                                                             C. APPLICANT CAN CHOOSE ANY  1 / ANY 5 /FULL MODULE                                                                                                      D. FEES ONCE PAID WILL NOT BE REFUNDED *
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