4. ENROLLMENT FORM FOR PARTICIPANT
9th Girimitra Sammelan - 11st July 2010
*Name: ___________________________________________________
*Address: ___________________________________________________
___________________________________________________
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*Contact: *Res.:__________________ *Cell:____________________
*Email: __________________________________________________
Blood Group:____________ Date of Birth: ______________
Occupation: ____________
Experience in Mountaineering with achivements:
Sahyadri: ______________________________________________________
______________________________________________________
______________________________________________________
Himalaya: ______________________________________________________
______________________________________________________
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Have you attended any Workshop or Seminar or Mountaineering previously?
If yes, please give details:
_________________________________________________________________
_________________________________________________________________
Are you a member of any club or Mountaineering organisation? Please specify.
_________________________________________________________________
_________________________________________________________________
*Date: _________ *Signature: _________
Participant Please Note:
Fields which are marked with * are compulsory.
If the * marked field are not filled, form will not be acceptable for participation.
Collection Centre Please Note:
Please do not accept form if the * marked fileds are not filled.