REGISTRATION FORM (JULY-2024)

Personal Details / व्यक्तिगत विवरण
Student Name / अभ्यर्थी का नाम *		.jpeg,.jpg,.png Format Supported .jpeg,.jpg,.png Format Supported
Father's Name / पिता का नाम *
Mother's Name / माता का नाम *
Gender / लिंग *
Date of Birth / जन्म तिथि *
Marital Status / वैवाहिक स्थिति *
Mother Tongue / मातृभाषा *

Contact Details / संपर्क विवरण (In Case of minor Parents details will be given)
Mobile Number / मोबाइल नंबर *
Email id / ईमेल आईडी *

Permanent Address Details / स्थायी पता विवरण

Permanent Address (Including Pin Code) / *
स्थायी पता (पिन कोड सहित)


State / राज्य :	District / जिला :	Pin Code :

Educational / Qualification Details / शैक्षिक / योग्यता का विवरण

Enter Your Professional/Educational Details *

Select Your Profession
Select Your Education Qualification	Enter Your Institution Name
Select Your Profession	Enter Your Organisation Name

Information
From where you learnt about National Space Club *
Language Preference *

Membership
Select Your Membership Plan *

Personal Declaration :- "I do hereby declare that all the statements made in the application are true, complete and correct to the best of my knowledge and belief. I am duly aware that in the event of any particulars or information furnished by me is found to be false/incorrect/incomplete or if I am found indulging in some unlawful act at any time during the course period, my candidature is liable to be summarily rejected/cancelled."Additionally undertaking for students whose results are awaited: "I, having been permitted to be provisionally admitted to University hereby undertake to produce the proof of having successfully qualified in the final qualifying examination with requisite percentage of marks if failing, I shall forthwith vacate the seat and shall have no claim for refund of fees already paid."