Participant Registration - Malvia Training Center

First Name *

Last Name *

Date of Birth *

Gender *

Email Address *

Mobile Number *

Current Address *

PIN Code *

District *

State / UT *

State / UT *

HEI Type *

University Name *

College/Institute *

Location (College/Institute) *

Designation/Position *

Department/Subject Area *

Years of Experience

HEI Email Address

Research Areas/Interests

Program Name *

Program Category

Start Date

Duration

Training Mode

Venue

Program Description

Profile Photo *

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Bank Passbook (Front Page) *

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I hereby declare that all the information provided above is true and correct to the best of my knowledge.

I agree to the terms and conditions of the training program.