Study Tour - Registration Form
Personal Information
Given Name
(as per passport)
:
Surname
(as per passport)
:
Date of Birth:
Gender:
Male
Female
Other
Nationality:
Passport Number:
Passport Expiry Date:
Contact Information
Email Address:
Phone Number:
Pan Number:
Present Address:
Passport Address:
Academic Information
Institution Name:
Institution Location:
Field of Study:
Year of Study:
Select One
1st Year
2nd Year
3rd Year
4th Year
French Language Proficiency Levels:
Select One
A1 - Beginner
A2 - Elementary
B1 - Intermediate
B2 - Upper Intermediate
C1 - Advanced
C2 - Mastery
Parent Contact Information
Parent Contact Name:
Relationship:
Parent Phone Number:
Others
Dietary Restrictions:
Vegetarian
Vegan
Non-Vegetarian
Any other
Any other information, you need us to know:
List of Countries Visited:
Yes
No
Countries Visited :
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Democratic Republic)
Congo (Republic)
Costa Rica
Croatia
Cuba
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
S?o Tom' and Pr ncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Document Upload
[Only PDF files accepted. File size must be less than 1 MB.]
Student PAN Copy:
Student Aadhar Copy:
Student Passport Front Page:
Student Passport Last Page:
Previous Travel Visas if any:
Parent PAN Copy:
Parent Aadhar Copy:
Payment Information
Payment Reference No.:
Amount :
I hereby confirm that the information provided above is accurate and I agree to abide by the rules and guidelines of the study tour.
© 2024 Immersion India