Nhi Participant Application Form

Application Form Name of the Course:

Principles of Nutrition (SKU No-SRV0028ID)

Cost of the course Venue Eligibility

Rs 4,500/-(Payment mode: cash/draft/credit or debit card) ADC Min. Higher secondary pass and 6 months as an ABO.

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Please fill up this form and submit it only at the ADC / PUC where the course is being offered. Call the Regional Call Centre to check this out. You will be allotted a batch on a first come first serve basis as per availability.

Personal Details ADA No:______________

Please write name in Capitals as to appear on Certificate.

Name of participant:

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Address:

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First name

Middle Name

Surname

City and Pin Code Contact Cell No: Date of Birth: ---------------------------- (dd-mm-yyyy) Educational Qualification: -------------------------------(min. Higher secondary pass) Languages known ----------------------------------------Occupation ………………………………… Average monthly PPV in Nutrition ----------------------Name of Course: Duration:

“Principles of Nutrition” 24 hrs + 2 hrs test

Location and Start Dates:

Refer the Amway office notice board or call Regional Call Centre

Mention the Location and start date suitable to you as per availability at the ADC: If you need to book your seat for a later batch: Please Note:

____________________________ Contact RTM / RT – Nutrilite

You will be allotted a batch as per availability in the current or next months’ batches.

Kindly note the following: • • • • •

Please attach two passport size photographs and Photocopies of Higher Secondary and graduation Certificates There will be NO PV /BV awarded for the course. There is NO refund of Course Fees nor is this transferable to another person/ date/ time. You will get your “Study Pack” as soon as you Register after depositing the Course Fees. You would need to attend at least 75% of the classes to appear for the final test. One Retest would be allowed for the candidate along with another batch. Please keep your Receipt for the course fees so that it enables you to appear for the Retest.

Process for submitting the NHI Application Form • • • •

Fill in this form and show to DCS for verification of Educational Certificates. Submit verified form to Cashier with course fees. You may call the Regional Call Centre/DCS, ADC to confirm your batch no. and timing. You will need to reach venue at least 15 mins before class starts.

Signature of Participant

Date:

Invoice No. and date:---------------------------------------( to be filled in by Cashier)