ATAL BIHARI VAJPAYEE INSTITUTE OF MOUNTAINEERING AND ALLIED SPORTS, MANALI (ABVIMAS)
Tel: (01902)-253841,252342, 250337 Tele fax: (01902)252137
Website: www.adventurehimalaya.org email- dmas_manali@yahoo.com,abvimasmanali@gmail.com
NAME OF THE CENTRE AT WHICH THE COURSE IS TO BE ATTENDED
NAME OF THE COURSE
DURATION TO CODE
01. NAME
02. FATHER’S/HUSBAND’S NAME
03. DATE OF BIRTH 4. SEX M F
05. ACADEMIC QUALIFICATION
06. OCCUPATION/ PROFESSION
07. TELEPHONE NO.
08. E-MAIL ID
09. ADDRESS
PIN CODE
10. DD/CHEQUE/RTGS/NEFT NO
DATED
AMOUNT
I agree to abide by/ adhere to the discipline of the Institute during the course failing which I am liable to expulsion. In case of
accident/ injury I will not hold the Institute partially or wholly responsible. I have read the rule and regulations of the Institute
and have fully understood the meaning and significance of the same. The above entries have been made by me and are correct
to the best of my knowledge and belief.
Place
Date
Applicant’s Signature