Gymnasium Form - National Institute of Technical Teachers

jk"Vªh; rduhdh f’k{kd izf’k{k.k ,oa vuqla/kku laLFkku] Hkksiky
National Institute of Technical Teachers Training & Research, Bhopal
NITTTR , BHOPAL GYMNASIUM (Application Form)
1. Name :
2. Date of birth :
3. Gender :
4. Cell phone number :
Affix your Self
Attested
Passport size
photograph
5. Father’s/Guardian’s name :
6. Mobile number :
7. Blood Group :
8. Permanent address
.................................................................................................................................
...........…..................................................................................................................
(City) ..................................................(District) .....................................................
(State).................................................(Pin code)....................................................
9. Name of the local guardian) ...................................................................................
10. (Relationship)...........................................................................(Address)................
.................................................................................................................................
11. Mobile number .......................................................................................................
12. Whom to contact in an Emergency .........................................................................
13. Mobile number ........................................................................................................
14. Room no. allotted (for students only).......................................................................

jk"Vªh; rduhdh f’k{kd izf’k{k.k ,oa vuqla/kku laLFkku] Hkksiky
National Institute of Technical Teachers Training & Research, Bhopal
UNDERTAKING
This is to confirm that I have read and understood the rules and regulations of the
NITTTR Gymnasium. These are acceptable to me and I shall abide by them.
Signature of Applicant
IMPORTANT RULES GOVERNING THE USE OF THE NITTTR GYMNASIUM
• Application form for membership is available in the Gymnasium NITTTR, Bhopal
• Members are required to deposit their Identity card with the Attendant before entering the
Gymnasium.
• Eatables are not allowed to be taken inside the Gymnasium Hall.
• Full value will be charged for any damage to the Gymnasium property by the members,
or their dependents.
• Courteous behavior is expected from all the members in the hall. Indiscipline or violation
of rules will entail suspension, cancellation of membership.
• No member shall inter-fare with the duties of any staff of the Gymnasium.
• The staff on duty accepts no responsibility for the safety of property of members, their
dependents, or of their guests, clothing etc.
• Members are advised not to bring money or valuables into the Hall.
• Smoking in the premises of the Gymnasium is strictly prohibited.
• Outsiders are allowed only with the undertaking of two existing members after depositing
the required fees
UNDERTAKING FOR OUTSIDER
Signature of the member/applicant
This Certify that I Know Mr./Ms. ___________________________________________ Since Last_____________Year.
And his/her living address is_______________________________________________________________________________
1. Name of Member: ______________________________________________________
Signature:________________________________________________________________
Member ship No.:_______________________________________________________
Address:_________________________________________________________________
2. Name of Member: ______________________________________________________
Signature:________________________________________________________________
Member ship No.:_______________________________________________________
Address:_________________________________________________________________

jk"Vªh; rduhdh f’k{kd izf’k{k.k ,oa vuqla/kku laLFkku] Hkksiky
National Institute of Technical Teachers Training & Research, Bhopal
Name______________Father’sName__________________Class/Deptt.___________Faculty//St
udent/Employee/Dependent on________________/Rtd. Employee of NITTTR certified that all
the particulars given by him/her are correct according to the office record. It is recommended
that he/she may be enrolled as a member.
Date: ______________
Head of the Department
(With Seal)
Reciept
Name______________Father’sName__________________Class/Deptt.___________Faculty/
Student/Employee/Dependent on________________/Rtd. Employee of NITTTR is allowed to
use the Gymnasium Hall. The applicant is permitted up to __________________________on
payment of `. ______________ per month.
Signature of the Prof. Incharge
Registration fee (for all categories)
` 50/- Per Session
Identity Card fee
` 50/- Per Session
Membership Fee
Campus Students ` 200/-
Faculty of NITTTR & their dependent Sons/
daughters. Non teaching employee & their
` 200/-
dependent Sons/ daughters.
Outsiders ` 400/-