SAINIK SCHOOL TILAIYA
PO – TILAIYA DAM, DIST – KODERMA, PIN – 825 413

REGISTRATION FORM
FOR ATTENDING GOLDEN JUBILEE CELEBRATIONS ON 15-16 SEP 12

1. Name of Guest Attending:  
(Pls prefix/ suffix rank & decoration, if any)  
2. Relationship with Tilaiyan:
3. Name of Tilaiyan:  
{if not “Self” at Sl (2)} {Pls prefix/ suffix rank & decoration, if any}
4. Tilaiyan Category:  
(Principal/ Headmaster/ Registrar/ Teacher/ Adm Staff/ Old Boy)
5. Nest at SST  From:    To:
 
6. Emp/ School No:  
   
7. Date of Birth:  
  MM/dd/yyyy
 
8. Present Address:   
 
9. Permanent Address:  
 
10. Contacts:    Tel No.   Fax
           MobNo.  Email      
11. Present Occupation:      
 
12. Marital Status:      
 
13. Meal preference:      
 
14. Name of Spouse:        
 
15. Date of Marriage:
MM/dd/yyyy  
     
 
16. Details of spouse & children attending
Sl No Relationship Name Age Meal Preference
A
B
C
D
17. Itinerary:
 
  Date Time Mode Flt / Train No Pick up/ Drop Requirement*
Arrival
MM/dd/yyyy
Departure
MM/dd/yyyy
   
19. Any special assistance required?
 
   
20. Would you like to purchase any of the following memorabilia?
   
 
Sl No Item Size Rate Quantity Total

Preferred Mode of Payment:


At Par Chq/ DD in favour of “Principal Sainik School Tilaiya” payable at SBI, SST (Code 3502)

A. Gold Plated Tie
Pin with Logo
- 250
B. Tie Pin/ Cuff Link/
Lapel Pin Set
- 525
C. Pens on Stand
with Watch
- 325
D. Set of 5 Wooden
Logo Keyring
- 350
E. Adidas House
Colour T-Shirt
S / L / XL / XXL
House____________
400
F. Adidas Golden
Jubilee T-Shirt
S / L / XL / XXL 400
G. Adidas Track Suit
with School Logo
S / L / XL / XXL 1500
H. Adidas J-11
Sports Shoes
5/6/7
8 / 9 / 10
1725
  • Items subject to availability of sizes.
  • Cost of items is subject to change.
  • More items will be added. Pls check website.
Grand Total
   
21. Your valuable suggestions:-