1

Name in Full: Prof. / Dr. / Mr./Mrs.

Mr. Supremaker.  M

2

Present Position/ Designation

:

3

Address

:

Flat No. 103, Plot No.41, Dr. A.S. Rao Nagar, ECIL Post, Hyd-500 062.

4

Phone No

:

040-5522309/9246186484

5

Fax No

:

6

E-Mail

:

7

Name of the College from where he / she has studied last

:

O.U. Arts College(University Campus)

8

Courses studied

:

M.A. Eng Litt., & M.C.J.(Journalism)

9

Year(s) of Study : From - To

:

1985-1990

10

Payment for membership is being made as  under

:

11

Cheque / DD No

:

13

Date

:

14

Bank

:

15

Amount (Rs)

:

Rs.500/-