E–Course: Design of Wastewater Treatment Units
 
A. Personal Details
Name * :
Permanent Address :
Correspondence Address :
E-mail ID * :
Telephone * :
Fax :
Date of Birth :  (DD/MM/YYYY)
Category :
B. Academic Details
Academic Qualification (with proof)
Educational Qualification Board/ University Year of
Passing
Percentage/
CPI
Diploma
B.E. / B. Sc.
M.E. / M. Sc.
 
C. Employment Details
Employment History (List from the most current employment in descending order)
Name of Employer Designation From To
 

Application Fees Payment Details
The Demand Draft/Cheque of Rs. 9000/- participants (excluding 14% service tax). The fee should be drawn in favor of “Gujarat Energy Research and Management Institute” payable at Gandhinagar, Gujarat.

Please find below the Bank Account details for RTGS & NEFT transfer
Bank Name: Corporation Bank
Bank Address: UdyogBhavan Branch, Gandhinagar - 382011
Bank Routing: IFSC: CORP0000583
Bank Account: 058300101006499

DD Amount: (Rs.)
DD No. and Date:
Drawn on (Bank & Branch name):

For any Enquiry: Please contact
Ms. Monika Panchani
Environmental Engineer
M: 9913936136
Email: monika.p@germi.res.in

Ms. Narinderjit Kaur Sethi
Dy. Manager Training & Development Center
M: 8141800167
Email: narinderjit.s@germi.org


DECLARATION

I have carefully read the details given about the course and other requirement on www.germi.org. I do hereby agree to abide by the decisions of the Institute regarding my selection to the course. I certify that the information furnished in this application form is correct to the best of my knowledge and belief.

I have read and completely understood, and agree to the Terms & Conditions for the Environment E-Courses.