For Office use only

Registration No. :
R. No. : ______

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Registration Form

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pD[NJFZGL DFlCTL
GFD o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
HgD TFZLB o PPPPPPPPPPPPPPPPPPPPP HgD :Y/ o PPPPPPPPPPPPPPPPPPPPPPPPPPP ;DI o PPPPPPPPPPPPam/pm - ZF+[/lNJ;[
p\DZ o PPPPPPPPPP JQF" l
p\RF. o PPPPPPP O}84 PPPPPPPPP .\R l
JHG o PPPPPPPPPPPPPPPPP SL,M
VeIF; o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
lJX[QF p5,aW o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
CF, X]\ SZM KM m o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
JFlQFS VFJS o ~P PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPD\U/ / XlGPPPPPPPPPPPPPPPPPPPPPP

S]8]\A lJQF[ DFlCTL

7FlT o PPPPPPPPPPPPPPPPPPPPPP 5[8F 7FlT o PPPPPPPPPPPPPPPPPPPPPPPP S]8]\AGM jIJ;FI oPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
l5TFG]\ GFD o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
DFTFG]\ GFD o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
D}/ JTG o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP HgDF1FZDF\ DFGM KM m o o
CF / o
GF
GFD o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
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;ZGFD]\ o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP5LG SM0 o PPP PPP PPP PPP PPP PPP
OMG G\P o STD CODE ;FY[sPPPPPPPPPPPPPPf PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
DMAF., G\ o PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
e-mail : PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
lJX[QF GM\W o sH[D S[ XFZLlZS BM0BF\564 0FIJM;L4 lJWJF4 lJW}Z JU[Z[Pf
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
p5ZMST DFlCTLGL ;tITFGL VDM BF+L VF5LV[ KLV[ H[ Vaishvav Yuva Parichay Directory DIWALI 2012- DF\ 5FK/ NXF"jIF D]HAGL lJUT 5|DF6[ 5|l;wW SZJF lJG\TLP
PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
pD[NJFZGL ;CL
TFP PPPPP / PPPPPP / PPPPPPPPPPPPPPPPP

PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
l5TF / DFTFGL ;CL
TFP PPPPP / PPPPPP / PPPPPPPPPPPPPPPPP

Details of Cheque / DD enclosed : (Rs. 600 / in favour of FONTACY GRAPHICS)

Chq. / DD No. ______________ Dt. _____________ Rs. _____________
Bank : ________________________________ Branch : ______________________________

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pD[NJFZGF OM8MU|FOG]\ 36]\ H DCtJ K[P DM8FEFUGL 5]l:TSFVMDF\ a,[S V[g0 jCF.8DF\ VG[ ;FWFZ6
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s5f e-mail YL photo DMS,JF .rKTF pD[NJFZM DF8[ VUtIG]\ o Format of file : .jpg l
Size : 4 X 5
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Resolution : 300 dpi l
File Name to be as name-city.jpg (e.g. Puja-shah-mumbai.jpg)
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Photo must be sent through the e-mail id mentioned in the form.

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VFD\+6P HFC[ZFTGF\ EFJ GLR[ D]HA K[P R[S FONTACY GRAPHICS GF GFDGM ,BXMP
FULL PAGE COLOUR ADVT. (Size : 242 mm Height X 178 mm Width) :
HALF PAGE COLOUR ADVT. (Size : 118 mm Height X 178 mm Width) :

Rs. 10,000 /-Rs. 5,000 /--

Please send your advt. matter and cheque to : Fontacy Graphics FF-29, Manas Complex,
Near Jodhpur Char Rasta, Satellite Road, Ahmedabad - 380015. Phone : 079-26921617