Application Form

Workshop Application-Form

Workshop Topics *

Initials *

Name *

Gender *

Date of Birth *

Email Address *

Mobile Number *

Address *

Locality *

City *

State *

Pincode *

Country *

Select Nationality *

Qualification *

Speciality *

Name of Current Organization *

Position *

Job Area *

Type of Applicants *

Sponsorship *

Name of the Sponsor (if any)

Sources of Information about this Workshop *

You are allowed to upload JPG, JPEG, PNG and PDF files only. Maximum upload file size limit is 250KB.

If PHFI / IIPH staff /student, please upload letter of recommendation from supervisor / PI / course coordinator

If foreign national, please upload letter of nomination on parent/sponsoring organisation’s letterhead

If foreign national, please upload image of your passport (colored image)

I hereby declare that the information given in this application is true and correct to the best of my knowledge and belief.