Registration Form

C-54, Ground Floor,

Near Priya Gold Building
Sector-02 NOIDA UP-201301 PHOTO

Full Name: _______________________________________________ (First name for badge)____________________________

University/Organization: ___________________________________________________________________________________
Preferred Mailing Address:__________________________________________________________________________________
City: ________________________________ State/Province: ______________________ Zip/Postal Code: _________________
Country: _____________________________ Telephone: (______)__________________ Fax: (______)____________________
Email: __________________________________________________________________

FEES
1. Registration Fees
POSTMARKED & PAID
PLEASE CHECK APPROPRIATE REGISTRATION FEE: BEFORE JOINING AFTER JOINING
Super 5 (who scored above __) Free Free
Non-Super 5 (who scored bw __-__) ______ INR _______ INR

Sign____________

If you received a scholarship, check Do not pay a registration fee. Still complete this registration form.

2. Educational Details

Standard Board Session Aggregate percentage

10th
12th
B.TECH

Cancellations/Changes and Refunds: Fees will be refunded, less a 10 % processing fee, if cancellation or change resulting in a refund is
received in writing. After that date, fees are non-refundable. All refunds will be processed after the conference. Substitutions are allowed at no
charge.

Please mail or fax completed registration form to: C-54, Ground Floor
Phone: 0120-4546100 Near Priya Gold Building
Cell: 8010805667 Noida Sec-02
Email: hr@4achievers.com UP (201301)
Website: www.4achievers.com