Thursday 25 April 2013
registration form
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<center><img src="C:\Users\DINKAR\Desktop\Form\mgm.jpg" height="60" width="60"></center>
<center><h1>MGM College Of Engineering & Technology</h1></center></img>
<center><h2><font color="red"> <u> APPLICATION FOR ADDMISSION</u> </font></h2><br>
REV. <input type="checkbox" name="rev">  
Mr. <input type="checkbox" name="mr">  
Mrs. <input type="checkbox" name="mrs">  
Miss <input type="checkbox" name="miss">  
Ms. <input type="checkbox" name="ms"> </center><br>
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Surname : <input type="text" name="sname" size="40"> Firstname : <input type="text" name="fname" size="40">
Date of Birth : DD <input type="text" name="dd" size="2"> MM <input type="text" name="mm" size="2"> YY <input type="text" name="yy" size="4">
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<u><b><big> Address for correspondence:</big></b></u>
Street name and number : <input type="text" name="street" size="110">
Suburb : <input type="text" name="suburb" size="25"> State : <input type="text" name="state" size="23"> Post Code : <input type="text" name="pcode" size="25">
country : <input type="text" name="country" size="25"> Email : <input type="text" name="email" size="82">
Tel.Home : <input type="text" name="home" size="25"> Buisness : <input type="text" name="state" size="25"> Fax : <input type="text" name="state" size="25">
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<b><u><big>Secondary school studies :-</big></u></b>
<textarea cols="118" rows="8"></textarea>
<big><b><u>Univercity,college, institute, etc.,studies :-</u></b></big>
<textarea cols="118" rows="12"></textarea>
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<b><u>Declaration :-</u></b>
I declare that the information submitted above is correct and complete.
Student signature : <textarea cols="37" rows="2"></textarea> Date : <input type="text" name="date" size="25">
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