Indian Institute of Plantation Management Bengaluru (An Autonomous Organization of the Ministry of Commerce & Industry, GoI)

One Week Short Term Training Programme on

Branding of Agriculture Commodities and Rural Marketing for Rural Transformation

24-29 June 2019 Registration Form

1. Name :

2. Is your Institute / College /Dept. AICTE approved

: Yes / No

3. Date of Birth & Age :

4. Sex : Male / Female

5. Designation :

6. Department :

7. Institution :

8. Type : Govt. / Aided /Self financing

9. Designation, Organization name and address If, working in Corporate

:

10. Address for Communication :

11. Contact Phone No. Mobile Whatsapp

: :

12. Email :

13. Experience (years) Industry Teaching

: :

14. Specialization :

15. Courses Handling :

16. Accommodation required : Yes / No

DECLARATION

The information provided above is true to the best of my knowledge and belief. If selected, I agree to abide by the rules and regulations of the training programme and shall attend the course for the entire duration, I also undertake the responsibility to inform the coordinator well in advance, in case I am unable to attend the course. Place: Date: Signature of the applicant

SPONSORSHIP Mr./Mrs./Dr.……………………………………………………………………………………..is a permanent employee of our institute /organization and is hereby sponsored for the above short term training programme. He / she will be permitted to attend the course, if selected. Place: Date: Signature of the Employer/Head of Institution