" APPLICATION FORM "

Name (in block letters) :
Father / Husband Name :
Date of Birth :
Sex :
Qualification
Present Address (in block letters) :
City :
Postal Zipcode / Pincode :

Country :

Permanent Address ( block letters) :
City :
Postal Zipcode / Pincode :

Country :

Phone :
E-mail :
Language in which study material
is required :
English    Hindi

Amount of Fees sent by M.O. / Draft :

Date :

Receip No. / Draft No.

P. O. / Bank :

Course Selected :

I solemnly declare that the above facts are correct to the best of my knowledge and belief.

 

 

Copyright © '02, '03, '04. Institute of Alternative Medicines and Research
189, Diamond Harbour Road (1st Floor), Thakurpukur, Calcutta - 700 063 (West Bengal) India.
Telefax : +91-33-2453 0788   Mobile : 91-98310 52162 (24 Hours)


WARNING :
No part of this Website should be Reproduced, Stored in a Retrieval System, or Transmitted by any means, Electronic, Mechanical, Photocopying, Printing, Recording, etc., without the written permission of
Institute of Alternative Medicines and Research.