National Workshop on Assessment Methods for Learning Evaluation

in
Basic Medical Sciences

Application Form for AMLE AIIMS 2008

22-24 September 2008

Name:                        

Age:                                 Sex:

Designation:                                                                                                                                      

Department:

Institution/College:

Complete Address:

Accommodation required:     Yes:               No:

[Only for selected participants on advance payment of INR. 1,000/- by Bank Draft]

Tel. no: Mobile:                                                    Other

Fax no:

Email address:

[Mandatory ]

Statement of purpose: Why do you wish to attend this workshop?

[Not more than 200 words. Please attach a separate sheet.]

Applicant’s Signature                                                                                Signature [Head of the Department]

Date:                                                                                                                                   Seal

Send duly filled in Application forms to:

Dr. Anjana Talwar
Organizing Secretary,
Department of Physiology,
All India Institute of Medical Sciences,
Ansari Nagar, New Delhi -  110029.

Tel no. 011-2659-4812. Fax no. 011-2658-8641. E-mail: AMLE.AIIMS@gmail.com

                    Last date of receipt of applications: 30 June 2008.