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1. Name of participant 2. Sex 3. Date of Birth 4. Designation (for faculty) or Degree Registered (for student) 5. Department, University 6.

Full Address 7. Email ID: 8. Area of research / teaching 9. Experience (Years) 10. 11. 12. Details of collaborative NRCM project (if any) Contact details: e-mail, fax, and telephone number Recommendation (by Head of the Institution, with seal)

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