Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 2

EXCEL SKILLS

todays training is tomorrows skill


12 lead ecg course
____________________________________________________________

APPLICATION
FORM date_________

TO,

THE CHAIRMAN

EXCEL SKILLS

Sir,

I am interested in participating in 12 lead ecg course.

My full details are given below.


[BLOCK LETTERS ONLY]

1] NAME:-__________________________________________________________________________________________________

2] MOBILE NO.______________________________________________________________________________________________

3] E-MAIL ADDRESS (RECOMMENDED):-________________________________________________________________________

4] QUALIFICATION DETAILS (TICK MARK)

COURSE YEAR

M.B.B.S ___________

B.H.M.S ___________

B.A.M.S ___________

B.U.M.S ___________

POST GRADUATE ___________

NURSING ___________

5] ADDRESS:-

________________________________________________________________________________________________________

_______________________________________________________PINCODE______________TEL NO ____________________

SIGNATURE

Office use only

Registration no________________________________ fees_______________

You might also like