HTC Registration Form

(Please fill this form in capital letters only)

Traning Program Details :
(Please refer to the schedule of programs)
Name of the Course:
Date you wish to join:
Personal Details:
First Name Middle Name Last Name
Postal Address:
alu!a : District : "tate :
P#N $ode
el No%: Fa& No%: Mo'ile No%:
(mail #d:
(ducational )ac!ground:
Profession:
Farm Details:
Locality: Area: (ha%)
$rops *rown:
Do you ha+e a *reen house: ,es - No
.hat are the crops grown under it:
Employment (if Applicable):

Name and address of organi/ation
with which you are employed:
ype of 0rganisation :
Language of instruction desired: (nglish - Marathi
.hat are your o'jecti+es in joining
this course:
(Please affi&
passport si/e
photograph)
Fees:
For one wee! course: 1s% 23455-6
(his fee is inclusi+e of tuition3 residential accommodation3
food and technical literature - printed material)
Enclosed Please find Che!ue" DD no# $$$$$$$$$$$ dated $$$$$$$$$ dra%n on $$$$$$$$$$
&an'#
(The Cheque/ DD should be in favour of NIPHTs Horticulture Training Center a!able at
Talegaon Dhabhade "