REGISTRATION FORM – 2024-2025 Name of the Center Owner: Father's Name: Date Of Birth: Name of the Trust/Society/Registered Institute/Others: Postal Address : City State PIN CODE Email Address: Mobile Number of the Director: Alternate Number of the Firm: Name of the Study/Information Center: Address of the Study/Information Center City State PIN CODE Assessment of the Center with respect to the location : Commercial/ Residential: CommercialResidential Owned/On lease/ Rented etc: OwnedLeasedRented Center Head Photo Principal Office Building Photo Trust or Society Photo Lecture Room 3 Lab Form Submit