Online Application form

Membership fee : 100 Rs. T shirt Price : 220 Rs.
NAME OF CENTRE
Password (10 characters maximum)
(Please remember this password as it will be required for editing your application and downloading admit cards at a later stage.)
Confirm Password (10 characters maximum)
(Password and Confirm password should be same.)

PERSONAL
NAME Ms./Mr.
Upload passport photo here.  
FATHER’S NAME Mr./Dr.
MOTHER’S NAME Mrs./Dr.
SEX : Male Female Date of Birth
CATEGORY Gen ST NATIONALITY
OBC BC RELIGION (for statistical reports only)
SC    
If PC, Nature of PC OH VI Emergency Contact
HI None Phone No.

COMMUNICATION INFORMATION
MAILING ADDRESS PERMANENT ADDRESS
Is Permanent Address same as Mailing Address
STATE STATE
PIN CODE PIN CODE
Mobile: E-mail
PHONE NUMBER STD code:   Number:   Fax

T-Shirt Details (All Details are Mandatory)
T-shirt Size
Order QE Tshirt(you may purchase it Later) Yes No
Interests
Hobbies
Why Quarks Ensemble?
Declaration of Acceptance of Membership:
1. I solemnly declare that the information provided above is true to my knowledge and belief.
2. I promise that I will abide by the Constitution of the Club.