1st Inter-School Quiz Competition - E-paolive.net

1 st Inter-School Quiz Competitionin commemoration of115 th Lamyanba Irawat Birth Anniversary, 2011organized by:-Imphal West Students’ Club (IWSC), Khumbong(Date: 30 th September, 2011 at Khumbong Bazar )• Competition is open to three students from the same institution currently reading in Class VI to Class X• Please fill up this Form and email the scanned copy to us at asamarendra@yahoo.com or submit to the office ofthe IWSC, Khumbong• Entry fee is Rs. 50/- on cash payment at the IWSC office. Spot payment can be made for those who submittedthis application form through e-mail.• An institution can have only one entry.• Do fill all the columns. Wherever not applicable, do write ‘N A’.• The last date for emailing/submission of the form is 27 th September 2011• The best five (five) teams will be selected for the final round after a preliminary written test which will be heldon 30 th September, 2011 at 10.00 a.m.• There will be various rounds in the final competition comprising of oral, audio, visual etc.• Quiz Master’s decision on any answer will be the final and binding.• Prizes: Winner – ` 3000, First Runners Up - ` 2000 and 2 nd Runners Up – ` 1000 alongwith certificates to allcontestants.• For enquiries, please contact @ 9436287906, 9615345762, 9402958517ENTRY FORMName of the Contestant 1: ...............................................................................................................................Name of the Contestant 2: ...............................................................................................................................Name of the Contestant 3: .............................................................................................................School name: .................................................................................................................................................Contestant 1 Contestant 2 Contestant 3(Photographs of the participants attested by the head of the institution)Details of Contestant 1Name: .............................................................................................................................................................Class: ..............................................................................................................................................Date of Birth (dd/mm/yyyy): ..............................................................Sex (M/F): .......................... .................See overleaf

Details of Contestant 2Name: .............................................................................................................................................................Class: ..............................................................................................................................................Date of Birth (dd/mm/yyyy): ..............................................................Sex (M/F): .......................... .................Details of Contestant 3Name: .............................................................................................................................................................Class: ..............................................................................................................................................Date of Birth (dd/mm/yyyy): ..............................................................Sex (M/F): .......................... .................Details of the Institution:Institution’s name: .........................................................................................................................Name of the Principal/Head of the Institution: ............................................................................Name of the Contact Person (if not the Head of the Institution): ..............................................Mobile number of the Contact Person: ........................................................................................Institution’s Address: ....................................................................................................................Institution’s Email Id: .....................................................................................................................DECLARATIONI ................................. the Principal/Head of (name of the institution)................................................................................................................... located at (address of theschool/institution)........................................................................................................................................................................................................hereby declare that Mr/Ms ..........................................................................., Mr/Ms. and Mr/Ms ...........................................................................whosedetails have been provided above, is an entry from our School/Institution for ‘Inter-School QuizCompetition and to the best of my knowledge, the information provided in this form are true. Also, this isthe only team participating for this quiz competition representing the institution................ .................................................................................................Signature of the Head of the Institution(With the seal of the institution)Name________________________________Designation ________________________________