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ITC-13 Nomination Form

ITC-13 Nomination Form

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Published by Diana Kh

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Published by: Diana Kh on Jul 18, 2011
Copyright:Attribution Non-commercial

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07/18/2011

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`
NOMINATION FORMNOMINATION FORM
NAME: _
 __________________________________________________________________
AGE:
___________
SEX:
 __________
PASSPORT NO.
:_____________________________________________
(
Only for Non-Indian participants
)
DESIGNATION:_
 ___________________________________________________
ORGANISATION complete address : ___________________________________________________________________ ___________________________________________________________________Tel:_______________________Fax: _____________________Email : ______________________________________DURATION OF SERVICE IN THE PRESENT ORGANISATION:
Yrs / months
 ___________________________________________________________________NATURE OF RESPONSIBILITY IN THE PRESENT ORGANISATION: ___________________________________________________________________ ___________________________________________________________________
 
XIII International Training Course on Disability & Development
8
th
– 15
th
September 2011, Bangalore
 
`
 ___________________________________________________________________TYPE OF TRAINING/EXPOSURE UNDERGONE IN DISABILITY WORK SO FAR (INCLUDINGINSTITUTION WHERE SUCH AN ENDEAVOUR WAS TAKEN) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________EXPECTATIONS OF THE PARTICIPANT IN THE PROPOSED COURSE: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ARE YOU A PERSON WITH DISABILITY?
YES
 
NO
(If yes, kindly inform us if any form of arrangement has to be made)
 ___________________________________________________________________
Are you a lactating mother and wish to bring your child (if yes, kindlyinform us, so that we can be prepared) :____________________________ ________________________________________________________________
DETAILS OF PAYMENT OF COURSE FEE:
 ________________________________
SIGNATURE OF THE PARTICIPANT:
____________________________________
XIII International Training Course on Disability & Development
8
th
– 15
th
September 2011, Bangalore

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