Enrollment Form

Phone Number *

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Phone Number Two

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Name *

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Please enter no more than 30 characters.

Sex *
Male Female

Date of birth *

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District *
Aizawl Lunglei Siaha Champhai Kolasib Serchhip Lawngtlai Mamit Saitual Khawzawl Hnahthial

Address 1 (Khua / Veng) *

Only letters and a few special characters allowed..

Please enter no more than 30 characters.

Address 2 (House No / Street / Landmark) *

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Please enter no more than 30 characters.