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    This document is an application form for a Regional Centre of Excellence in Ayurved for Geriatrics Health Care's Regional Orientation Training Program (ROTP) in Geriatrics taking place from March 19-24, 2012. The applicant provides their name, father's name, date of birth, sex, registration number, education qualifications, current place of employment, department, designation, years of teaching and professional experience, number of CMEs/ROTPs attended in the current year, contact information, and signature. The head of the applicant's institution must also sign to certify the applicant's details and recommend them for the program without travel allowance, daily allowance, or honorarium, and consider them on duty leave including

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    This document is an application form for a Regional Centre of Excellence in Ayurved for Geriatrics Health Care's Regional Orientation Training Program (ROTP) in Geriatrics taking place from March 19-24, 2012. The applicant provides their name, father's name, date of birth, sex, registration number, education qualifications, current place of employment, department, designation, years of teaching and professional experience, number of CMEs/ROTPs attended in the current year, contact information, and signature. The head of the applicant's institution must also sign to certify the applicant's details and recommend them for the program without travel allowance, daily allowance, or honorarium, and consider them on duty leave including

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
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    119 views2 pages

    Registration Form

    Uploaded by

    dranilbh
    This document is an application form for a Regional Centre of Excellence in Ayurved for Geriatrics Health Care's Regional Orientation Training Program (ROTP) in Geriatrics taking place from March 19-24, 2012. The applicant provides their name, father's name, date of birth, sex, registration number, education qualifications, current place of employment, department, designation, years of teaching and professional experience, number of CMEs/ROTPs attended in the current year, contact information, and signature. The head of the applicant's institution must also sign to certify the applicant's details and recommend them for the program without travel allowance, daily allowance, or honorarium, and consider them on duty leave including

    Copyright:

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    of 2

    APPLICATION FORM FOR ROTP (Geriatrics) PARTICIPATION AT

    Regional Centre of Excellence in Ayurved for Geriatrics Health Care


    R.G.Govt P.G.Ayurvedic College Paprola-Himachal Pradesh
    To
    Nodal Officer,

    Regional Centre of Excellence in Ayurved


    for Geriatric Health Care
    R.G.G.P.G.Ayu.College & Hospital
    Paprola-H.P-176115.
    Sir,
    Kindly enroll me as participant for ROTP (Geriatrics) being organized by
    Regional Centre of Excellence in Ayurved for Geriatric Health Care from 19th March
    2012 to 24th March 2012.
    My brief Bio-Data is as below:
    Name--------------------------------------------------------Fathers Name---------------------------------------------Date of Birth-----------------------------------------------Sex----------------------------------------------------------Registration No: -------------------------------------------- (State-----------------------)
    Education Qualification-----------------------------------Name of Institution where presently serving---------------------------------------Department------------------------------------------------Designation-----------------------------------------------Experience in Years: a. Teaching--------------------------------b. Professional---------------------------Number of CME/ROTP attended during current year: --------------------Present Correspondence
    Address :-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Telephone Contact No: -----------------------------------------E.Mail : .
    Signature of Applicant
    Dated------------------Certificate of Head of Institution
    Certified that the particulars furnished above by applicant Dr..are
    correct as per records available with the institution. He is recommended for the ROTP
    applied without TA/DA or Honorarium. He will be considered on Duty Leave during
    ROTP period including Journey days.
    Signature
    Head of Institution

    Dated-----------------

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