SCHC

Registration Form

(Please fill the form and submit to SCHC. You can photocopy this form for additional registration.)

I am registering as *

1. Student of Distance Education Program Offered by SCHC:

2. Other Delegate

3. Alumnus

4. Medical / Law / Healthcare Student

5. *Accompanying Person

Full Name(In Block Letters): *

Roll No.: *

Gender: *

Telephone No.:

Email Id: *

Program/s Enrolled: *

Age: *

Mobile No.: *

Address: *

Accompanying Person Details:

Name

Age

Gender

Add More

Total Amount To Be Paid: *

Please Note:
1. Kindly keep the print of registration form handy to calculate the amount to be paid.
2. Contact us for any queries on: 91-88888-92258/ 020-25655023.
3. Student has to mail the completely filled registration form for National Seminar to distanceassistance@schcpune.org.