58th ANC Pre Registration Form 2016

1. College Code :

2. College Name :

3. Contact Details :

4. Name of HOD :

5. HOD Contact No. :

6. U Sec Name :

Gender
Male Female
Contact No. :
+91

email id :

7. U D Name :

Gender

Male Female

Contact No. :

+91

email id :

8. Faculty Name :

Gender
 Male Female

9. College Status

ANDC qualified college ANDC not qualified college (Only U.Sec And U.D)

10. No of delegates (maximum delegates allowed 25 excluding u.sec and u.d)

* Please fill this detail only if you are qualified

No. of girls

No. of boys

11. Date and time of arrival :

12. Mode of transport :

Air Train Bus

13. Date and time of departure :

14. Mode of transport

Air Train Bus