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CosmoClub Registration Form

Cosmofluencer > CosmoClub Registration Form

Personal Details

Name *

Email Address *

Phone *0 / 10

CityWhich City are you from?

StateWhich State are you from?

Education

School / College *

Class / Grade as of 31-Mar-24 *

Course *

Town (where the school / college is) *

Instagram Handle

LinkedIn Account

A Bit More

Why do you want to join this Club? *

What is your career goal – where do you see yourself in 10 years? *

If shortlisted, how would you like to be contacted? *Email (mentioned above)Whatsapp (number mentioned above)

Consent *

I permit Giant Leaps Foundation to reach out to me regarding the application to the program, through the details shared above.

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