Registration Form

HealthNet Nepal is going provide email services to it's LAN users, so please fill out this form to register online. (Only for the staffs)

Name (Last, First): (*)
Organization/Institution :(*)
Your Present Post:
Contact phone number and time:(*)
Your Email Address :(*)
Course Type :(*)
Payment Type:(*)	Amount Deposit vouchure sent by fax Amount will be deposited two days before the training date.

Note:

As there are limited number of seats available for the course the decision of the selection commitee will be final.
On-line form will be valid only when bank voucher deposited in the name of HealthNet Nepal is sent through fax on 4427684
Our account number is Himalayan Bank, Maharajgunj, 068790J.