DQ Labs Coaching - Registration Form
Please complete this form in full
Which City are you joining DQ Labs *
For Classroom coaching
Required
Student Name *
Full name as per your School / College Format
Parent Name *
Either parent or both
Student Date of Birth *
MM
/
DD
/
YYYY
Address for Communication - Line 1 *
House / Apartment Name
Address for Communication - Line 2 *
Street / Area Address
Pin Code *
Student Mobile Number *
if you dont have a mobile, give your parent mobile number
Parent Mobile Number *
Exam coaching you have enrolled for *
Required
Which Package have you enrolled for? *
If you want to access free material, please mention FREE
Approximate Month / Year of exam *
Approximate year Eg. June 2017 / May 2018
Student Email address *
Parent Email address *
Payment Details *
Cash / Cheque / NEFT / EDC with supporting document or confirmation number. If you are accessing free material, please mention FREE
Students School / College Name with address *
Give details *
From the options above, please provide a name of a reference or online platform where you heard about DQ Labs
How did you hear about us *
Required
Please upload your Passport Size Photograph (Scanned Copy) *
Please email a scanned copy of passport size photograph to info@dqlabs.in . Photograph is mandatory for account activation
Required
Any other comments
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