Registration Form

Note:

As there are limited number of seats available for the course the decision of the selection commitee will be final.
On-line form will be valid only when bank voucher deposited in the name of HealthNet Nepal is sent through fax on 4427684
Our account number is Himalayan Bank, Maharajgunj, 068790J.

Name (Last, First): (*)
Organization/Institution :(*)
Your Present Post:
Contact phone number and time:(*)
Your Email Address :(*)
Payment Type:(*)	Amount Deposit vouchure sent by fax Amount will be deposited before 12th Nov, 2003