ANDHRA BOOK OF RECORDS

APPLICATION FOR RECORD ATTEMPT

Magic House, Ryali - 533236, Dr. B. R. Ambedkar Konaseema District, A. P, 1, India

Cell: 8886765179 | Email: andhrabookofrecord@gmail.com

Please complete this application form to attempt a record with Andhra Book of Records.
Fields marked with (*) are mandatory.

PERSONAL INFORMATION

Name of the Applicant *

Date of Birth *

Address *

Phone Number *

Email *

Profession

RECORD INFORMATION

Record Title *

Description of the Record Attempt *

Location of Record Attempt *

Proposed Date(s) of Attempt

Number of Participants

Magic House, Ryali - 533236, Dr. B. R. Ambedkar Konaseema District, A, P, India

Cell: 8886765179 | Email: andhrabookofrecord@gmail.com

Web: www.andhrabookofrecord.com