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CRE-Registration form
Approved by Rehabilitation Council of India (RCI) Ref. No-7-16 (642) /2023-RCI
* Indicates required question
Email
*
Your email
Title
*
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Age
*
Your answer
Gender
*
Male
Female
Father Name
*
Your answer
Address
*
Your answer
State
*
Your answer
Postal /Zip code
*
Your answer
Mobile No
*
Your answer
Email ID
*
Your answer
CRR No.
*
Your answer
Qualification.
*
MASLP/M.Sc.(Speech/Audio)
BASLP/B.Sc. Speech & Hearing
Working As.
*
Professional
Student
Organization.
*
Your answer
Payment Options
*
Cash
payment Should be Demand draft(D.D)in favor of BASLP Course. Payable at Raipur(any nationalized Bank).
A copy of your responses will be emailed to the address you provided.
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