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Kalinga Banika Pratibha Award-2007
On Kartika Purnima, 23rd Nov. 2007
---------------------------------------------------------REGISTRATION FORM-------------------------------------------------------
1. Name :
2. Father's Name :
3. Date of Birth :	(dd/mm/yy)
4. E Mail Address :
5. Educational Qualification :
6. Name of the College/Organisation :
7. Address for Correspondence : (with Telephone No.)
DECLARATION :
I hereby declare that all the information furnished above is true and best of my knowledge.