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User Type  

Full Name 

Gender 

Male Female

Date of Birth

Occupation  

Organization  

Designation  

job responsibilities

Sector  

Current Location (city)  

Current Address 

Permanent Address 

Phone No 

Mobile No 

Attach Photo (image)  


Course 

From

to

Year of Graduation  

Additional Information 

Email 

(This email id will be used as login id)

Password  

Captcha  

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