INDIAN INSTITUTE OF SKIING & MOUNTAINEERING

(Ministry of Tourism, Government of India)

Telephone/Fax:-01954-254480, 0194-2312749
GULMARG (J & K)

Details of fee payment____________________________

Course subscribed for____________________________

1. Name ________________________________ Name of Parent ___________________

2. Nationality ___________

3. Date of birth _________________________ (Attach Proof)

4. Permanent Address________________________________________________________________

5. Tele /Mobile No__________________________ (b) Email________________________

6. Name and address next of kin____________________________________________

7. Vegetarian/ Non-Vegetarian _____________________________________________

8. Academic qualification & Current employment____________________________

9. Blood Group ____________ Identification Mark____________________

10. Medical History/ if suffering from any ailments________________________________________________

11. Any special qualification/hobbies connected with Skiing/Mountaineering/Aquatic/Sports, including Skiing Courses, Mountaineering Courses,

Water Ski Courses, if any attended earlier_______________________________________________________________________

12. Height ___________Weight ____________Waist ________________Shoe Size ____________Chest _____________

13. I Know that No liquor/smoking is allowed inside or outside the institute during the course.

14. I agree to strictly abide /adhere to the discipline and the directions of the Institute during the course failing which I shall be liable for expulsion.

Dated_______________ Signature of Applicant______________________________

I hereby certify that all the entries have been made correctly. I am medically fit to undergo the course. I am a volunteer and in case of any accident or injury I
shall not hold the Institute or any of its staff wholly or partially responsible for it and shall not make any claim to that effect. In case of loss of equipment, I
shall pay for the same as per institute rate list.

Signature of Applicant____________________________________

(In case of minors the parent/guardian should sign)

It is to certify that the age of above candidate as mentioned in this application is correct and verified by me.

Dated _________

Signature___________

(Principal of Institution / A gazetted officer with Seal)

(Application Forms may be photo stated as per requirement.)