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MENTAL ABILITY CONTEST
LEARNER REGISTRATION FORM
I. M. & H.E. ACTIVITY OLYMPIAD
DEAR LEARNER
PLEASE PASTE
YOUR LATEST
PICTURE
ON ME
Please fill in this IAO form in Capital Letters &
Submit before 10days of the IAO DATE,
on which you want to appear.
Please refer www.imhe.in,
www.facebook.com/imheolympiad
for detailed SCHEDULE
IAO LearneR No
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B
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0
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A LINE ABOUT MY SELF ………………………………………………………………………………………………………………………………….
CONTACT
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P
M
P
E-MAIL……………………………………………………………………………………………………………………………………………….
NAME IN FULL INITIAL
MOTHER'S NAME
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M
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Y
Y
FATHER'S NAME
D
D
M
M
Y
Y
GRAND PARENTs N.
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D
M
M
Y
Y
D
D
M
M
Y
Y
DATE OF BIRTH
D
D
M
M
Y
CLASS
Y
PARENT MARIG. ANNIV.
ADDRESS
CITY
PIN
STATE
SIBLING 1~
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D
M
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Y
Y
SIBLING 2~
D
D
M
M
Y
Y
FRIEND 1~
D
D
M
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Y
Y
SCHOOL NAME
SCHOOL ADDRESS
th
th
th
JUNIOR (3 – 5 Class)
MIDDLE (6 – 8 Class)
SENIOR (9th– 12th Class)
MUSIC
B1 DRAWING
A1 BLEEP UP D BRAIN
B2 WORD CHAIN
B3 SUDOKU
NOT FOR KIDS
B4 PICTURE PUZZLE
B5 WHO M I?
C
Class)
rd
GROUP A. PSYCHOMETRIC
GROUP
KIDS (1 – 2
nd
B
st
CHOOSE ANY
1 ACTIVITY FROM
'B' OR 'C'
TICK & CHOOSE YOUR CATEGORY
GAMES
GREEN 100/- YELLOW 70/-
GROUP
FEE RS. / ZONE WISE
ONLY KIDS
optional & free*
C1 GUITAR
NOT FOR KIDS
C2 KEY BOARD
NOT FOR KIDS
C3 SINGING
NOT FOR KIDS
C4 DANCE
Before filling the form, please read T&C / visit: www.imhe.in
www.facebook.com/imheolympiad
mail:[email protected] [email protected]
For T&C and other details: www.imhe.in - “I. M. & H.E. ACTIVITY OLYMPIAD ‘2015” - 4th “who m i? Terms & condition:
NO purchase necessary. Void where prohibited or restricted by law. Filling / applying manually or online means that you agree the terms & condition and do not have any
objection. By participating in this OLYMPIAD, You agree to comply with all of the terms and conditions. If you do not agree with any of the T & C, Do Not check in for “I.A.O.”
OLYMPIAD & Do Not submit an entry. Filling of all columns above is mandatory. Please give correct & legible details for ease of communication/issuance of certificates.
DATE
D
D
M
M
Y
LEARNER'S SIGNATURE
Y
PARENT'S SIGNATURE
...……………………………………………………………………………………………………………………………………………………………………………………………………….
TICK CATEGORY / ACTIVITY
K
J
LEARNER NAME
IAO LearneR NO.
A
B
PAYMENT MODE
CASH
M
S
X
A
B1
B2 B3 B4 B5 C1
N
G
K
C
1
0
D.D. NO.
0
1
C2
C3 C4 RECIEPT DATE
OLYMPIAD DATE
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M
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Y
Y
D
D
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Y
Y
OLYMPIAD VENUE
IAO 2015
VENUE ADDRESS
STAMP
ON ME
For I. A. O. OLYMPIAD
AUTHORISED SIGNATORY
FEE ONCE PAID WILL NOT BE ADJUSTED OR RETUN BACK*
C.O.: II-C, Nehru Nagar, Gzbd.
www.imhe.in, [email protected], www.facebook.com/imheolympiad, whatsapp 8285555501, +91 120 3293 677, 999 999 7287, 9717 123 001