PRATIBHANVESHAN – 2012 (QUIZ COMPETITION FOR GIRLS) For Senior Students (Class XI & XII)

1. Name and Address of School: ………………………………………… ……………………………………………………………………………. Participant 1 Registration Form PRATIBHANVESHAN – 2012 (QUIZ COMPETITION FOR GIRLS) For Senior Students (Class XI & XII) Photo Name: ……………………………………………….. Father’s Name: ……………………………………... Class: ………………………………………………… Correspondence Address:………………………………………….. ………………………………………………………………………… E-mail: ……………………………………………………………….. Contact No.: …………………………………………………………. Date: 6th December, 2012 (Thursday) Schedule Reporting at FASC Office : 9:00 – 9:30 AM Refreshment : 9:30 – 10:00 AM Quiz Time : 10:00 AM Onwards Lunch : 1:30 – 2:30 PM Prize Distribution : 2:45 – 4.00 PM Participant 2 Name: ……………………………………………….. Father’s Name: ……………………………………… Class: ………………………………………………… Correspondence Address: ………………………………………….. …………………………………………………………………………. E-mail: ………………………………………………………………… Contact No.: …………………………………………………………. Travelling Plan: ……………………………………………………… ………………………………………………………………………… ………………………………………………………………………… Name, E-mail and Contact No. of Accompanying Teacher.......... …………………………………………………………………………. Photo Contact Mr. Ashish Kumar Sharma, Mob: 09928367860 Dr. P. K. Jain, Mob: 09414971602 Note: • Each team consists of 2 students. • One teacher may escort students from one school. • More than one team can participate from one school. • There is no registration fee for participation. • Travelling Expenses will be reimbursed to the Top 10 ranked teams • (upto a maximum of Rs. 1,000 per team). • Free Accommodation will be provided to students from distant schools. • Free Lunch will be provided to all participants. • Participants have to carry their Identity Cards. • Participants from distant schools need to send their travel plans. • Deadline for entries is 30th November, 2012. Forwarded by:- (Signature and Seal of Principal) Prizes Rolling Trophy; Gold, Silver and Bronze Medals Cash Prize to Winners (I – Rs. 5,100; II – Rs. 3,100 and III – Rs. 2,100) Organized By:- Faculty of Arts, Science and Commerce (FASC) Mody Institute of Technology & Science Lakshmangarh-332311 http://www.fascmits.ac.in; aksharma.fasc@mitsuniversity.ac.in Note: Separate Registration form is required for each team. Xerox copy of the same can be used. Prior information of accompanying teachers / parents would be highly appreciated.