Course Registration

Fields marked * are required!

Name *
Program 1 *
Program 2
Father / Guardian Name *
Permanent Address *
Pin Code *
Phone (Residence)
Mobile
Email *
Current Qualification *	If Other, please specify
College *
Branch *
Semester *
Additional query/information (if any)
The registration fee is Rs. 1000.00 (Rupees One Thousand only) per program. If you are registering for 2 programs then you must deposit Rs. 2000.00 (Two Thousand only) towards registration. The amount is to be sent in the form of DD favouring "C IT ZEN" payable at Bhubaneswar.
DD No. *
DD Date. *
Issuing Bank and Branch *