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Republic of the Philippines

Department of Agriculture AGRICULTURAL TRAINING


INSTITUTEREGIONAL TRAINING CENTER
ASU Compound, Banga, Aklan
Tel. No. (036) 267-5951/267-6785
Telefax No. (036) 267-6786

PRE-REGISTRATION FORM
Printed Name Family Name First Name M.I.

Home Address District Province Municipality


Barangay Municipal Class Zip Code

Residence Tel. No./CP No.


Personal e-mail Address
Civil Status & Sex Civil Status: Sex:
Birthday & Birthplace Birthday: Age:
Highest Educational
Attainment
Degree/s Obtained

Do you have Rice Farming Experience?


Yes No

If yes, please indicate farming practice (direct/transplanted), type of ecosystem (rainfed/irrigated/upland), or area
planted, etc.:

Trainings attended related to rice production


Title of Training Inclusive Date Venue Sponsor

Other trainings attended


Title of Training Inclusive Date Venue Sponsor

Do you have knowledge in computer operations and office productivity?


Yes No

If yes, please check applicable boxes


MS Word MS Excel MS Power Point Others,
Do you have knowledge in the operation of rice farm machineries?
Yes No

If yes, please check applicable boxes

Hand tractor 4-wheeled tractor walk behind transplanter

riding type transplanter Combine harvester

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