Registration Form for "104 to Space"
Planetary Society India needs your help to communicate and Make astronomy reach to larger sections of people. Our Motto is "Cosmic Understanding for Universal Brotherhood" .
Name
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Name of the Institution where you are studying ? Address ?
Mention email, Website, Phone details if known.
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Class/Year Details ? Name of the Course you are pursuing ?
Your answer
Residential Address
This will help us invite/involve you in activity when conducted in your area
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Phone Number
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Your Email Address
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Educational QualificationsAchievements/Projects Done/Awards recieved if any ?
Please list all educational - Dont worry even if you are from Non Science Stream
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Click if you are interested ?
Please check (if you are interested)
Suggestions/Comments/Request you like to make
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Note: All the Information provided by you will be part of our Record and would be used for Educational Purpose only.
Thank you for submitting and watching our programme. Please Visit www.ournewplanets.info or www.facebook.com/planetarysocietyindia regularly.
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