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FACULTY ENRICHMENT PROGRAM Hyderabad

organized by IAPCHE in associa ion !i " #es$ey %egree Co$$ege& 'ec(nderabad

%a es) *+,-- Febr(ary& -.*/ REGI'TRATION FORM Na0e Age 1 %a e o2 3ir " %esigna ion5Ran6 Na iona$i y Pass7or N(0ber 82or 2oreign de$ega es on$y9 P$ace o2 iss(e %a e o2 iss(e %a e o2 e47iry Me0bers"i7 ' a (s) Ins i ( iona$ Address Indi:id(a$ Me0ber Ins i ( iona$ Me0ber Ti $e) 'e4) Ma$e 5 Fe0a$e E47erience

Fa4 Te$e7"one Residen ia$ Address

;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;; Ce$$ Te$e7"one e,0ai$ e,0ai$ Ins i ( iona$ Address Residen ia$ Address %ra2 No

Pre2erred 0ode o2 co00(nica ion Pay0en o2 Regis ra ion 3an6

(Drafts should be drawn in favor of Director, IAPCHE, A-O Region a!able at "agercoil, India#

'igna (re<
Reco00enda ion o2 "e Head o2 "e Ins i ( ion i2 2ro0 an Ins i ( iona$ 0e0ber o2 IAPCHE<

Head o2 Ins i ( ion<

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