AIMA CERTIFIED TRAINER (ACT)
APPLICATION FORM
Name :
Mr
Mrs
Miss
Dr
Prof
Date of Birth(DD/MM/YYYY):
Designation:
Organization:
ADDRESS FOR CORRESPONDENCE
City:
Pincode:
CONTACT DETAILS
Mobile:
Alternate Telephone No. :
Email
EXPERIENCE (NO. OF YEARS)
As a Trainer
In service not related to Training
ACADEMIC ACHIEVEMENTS
Qualification
Degree / Diploma
University / Institute
Year of Passing
Graduation
Post Graduation
Ph.D.
Any Other
Accreditation / Certification as Teacher / Trainer
DETAILS OF TRAINING DELIVERED
Organization / Client
Title of the Training Program
Duration of the Module Delivered
Date of Delivery
LIST OF ENCLOSURES
Payment
Are you a Member of AIMA
Yes
No
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