A-13, Kamla Nehru Nagar, JODHPUR-342 009(Raj.)
Telefax: 0291-2759042 Mobile: 94139 59698

E-mail : info@acupressureindia.com, acupressure@dataone.in

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APPLICATION FORM

I Wish to Register Myself for :

Name :

Sex :

 Male Female

Father's/Husband's/Guardian's Name :

Permanent Address :

Correspondence Address :

Phone :

Mobile :

E-mail* :

  

Date of Birth :

Nationality :

Profession :

Educational Qualifications :

Experience (If Any) :

Medium :

 Hindi English

Mode of Payment for Fee :

Cash UTI Bank D.D. Swift Code
(For payment information Go to Details)

Recommended By :

Course By :

 By Regular By Correspondence By Internet By Camp

Note : Plase include of your P/P Size Photo & Education Certificate photo copy.

This is to confirm that I wish to enroll myself for the course. I hereby declare that above information is true to the best of my knowledge.