Gl slc 2011 Academic Institutions Registration Form

PMI Pearl City Chapter, c/o CVM Solutions Pvt Ltd, 7-1-28/12/1, Serenity Plaza, Shyamkaran Road, Ameerpet, Hyd 500016

Contact – 040-40240178, 099898 45557 , Email – [email protected], [email protected], [email protected]

Website www.pmi-pcc.org

REGISTRATION FORM FOR ACADEMIC INSTITUTIONS / GROUPS

*Name of the Institute

(write in BLOCK Letters only)

*Communication Address

(Postal)

*Phone Number (Land line and Mobile)

Email id (if any)

Institute URL (if any)

Rural / Urban / Semi Urban

Name of Head of the Institute

Name of Faculty 1 / Student Escort1

(person from institution accompanying

the students)

Name of Faculty 2 / Student Escort1

(person from institution accompanying

the students)

Number of students in the group

(Please mention each student name

separately in the next sheet)

All Fields which are marked with * are mandatory. The student escort would be responsible for the group registrations, act as single point of contact on

behalf of the students and will handle all related activities for the registration

GYAN LAHARI – STUDENT

LEADERSHIP CONFERENCE - 2011

“Ignite the minds of youth to build a developed nation”




Conference Fees:

ACADEMIC INSTITUTIONS / GROUPS

ACADEMIC

INSTITUTIONS /

GROUPS

GROUP OF 1-8 GROUP OF 9-15 GROUP OF 16-25

RATE PER GROUP `3000 `4000 `5000

Registration fees should be paid as a single Cheque / Demand Draft in favor of

PMI Pearl City Chapter (payable at Hyderabad) for all the participants.

(Please mention your institution full name at the back of the Cheque / DD alongwith contact number

for us to contact in case of any discrepancies)

Please fill in the following details:

DD Number: Bank:

Date: Amount:

We hereby confirm that the above mentioned details are correct to the best of our

knowledge and we also understand that PMIPCC has the right to reject the registrations if

any discrepancy is found in the information provided by the institutes:

Location: Hyderabad Name of the

Head of Institute:

Date: Signature:

Institute Seal:




NAMES OF STUDENTS FORMING THE GROUP ( )

SR.NO NAME OF STUDENT AS IT SHOULD APPEAR IN CERTIFICATE

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Gl slc 2011 Academic Institutions Registration Form

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