ACUPRESSURE RESEARCH TRAINING & TREATMENT CENTRE



[pic]

AWARD APPLICATION FORM

Form No. __________

I wish to register myself for (Name of award)....................................................................................................

Name (In Block Latter) __________________________________________________________ Sex -M/F Father's/Husband's/Guardian's Name _________________________________________________________

Permanent Address_______________________________________________________________________

_________________________________________________________________Pin___________________

Correspondence / Present Address ___________________________________________________________

_______________________________________________________________________________________

Phone _______________Mobile ________________E-mail_______________________________________

Religion/Caste ___________________Blood Group__________Website____________________________

Date of Birth ________________ Nationality ___________ Profession/Occupation____________________

Educational Qualification ____________________________Additional Qualification________________ Experience _______________________________________________________________________

Process Charge: Cash /Bank /M.O./D.D./Net Banking/Other ______________________________________

Name & City as you wish on Certificate_______________________________________________________

Attached Documents/Report________________________________________________________________

Attached Treatment Case History____________________________________________________________

This is to confirm that I wish to enroll myself for the award. I hereby declare that above information is true to the best of my knowledge.

Place ______________ Date ______________ Your faithfully

For Office Use

Check by..................... Secretary.………………President....….. Signature of Applicant

Remarks.......................................................................................

-----------------------

Paste

PHOTO

Only One

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download