HIMALAYAN MOUNTAINEERING INSTITUE
JAWAHAR RARBAT,DARJEELING-734101

APPLICATION FORM
 
1. Name
(IN BLOCK CAPITALS)
2 Permanent Address
Phone no  Pin Code 
3. Date of Birth    Age on the date of application
4. Serial No. of the Course to be attended
BASIC / ADVANCE / MOI / ADVENTURE COURSE (Tick the correct one) Ser No )
5. Full Course Fee Rs  enclosed by Draft NoDt
6. Academic Qualification
Any special qualification or hobbies connected with mountaineering including courses, if any, attended  earlier.
(a)
(b)
7. Next of Kin with address & Telephone / if any.
8. >In case of any injury etc, that may sustain during the period of training. I will not hold HMI responsible >for the same. I want to undertake the course as per my own will.
>The above entries have been made by me and are true and correct.
Date
Signature of the applicant
Guardian ( in case of minor )