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Personal Information -
First Name :		Last Name :
Address :		Address Line 2 :
City or Town :		State/Province :
Zip / Postal Code :		Phone :
Date of Birth :		Email :
Occupation : (Tick one)	Student Housewife Employed Professional Business
Father's/ Guardian's Name :		Occupation :
Educational Qualification's :	Post Graduate Graduate BCA MCA Others
Stream :	Arts Commerce Science Management Others
If Studying, Please Specify :

How did you came to know about UAS Education?:
Newspaper	Hoarding	Wall Painting	Friends
Letter	Search Engine	Others Specify :
Pls specify which type of computer course would you like to choose?
Software	Networking	Hardware	Web Designing	Others
Which type of courses would you like to join?
Career Courses	Short Term Courses
Do you wish to seek Job Placement Assistance through UAS EDUCATION?

UAS Institute of Network & Technology - 250001
E-mail: info@uaseducation.ocm