ACUPRESSURE RESEARCH TRAINING & TREATMENT CENTRE
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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.......................................................................................
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