Registration Form

Please read the Terms and Conditions carefully before filling up the Application Form for the Above 10,000 Workshop. Please tick wherever necessary. All fields are mandatory unless and until specified otherwise. For online registration visit www.cmsacademy.org

Online Payment Click here

Above 10,000 Workshop Calendar for the Year 2010. Please tick your preferred schedule

S.NO	Batch	Schedule	Last Date for Registration	Last Date for Submission of Workshop Fees.
	First Batch	2-11 Oct	August 30, 2010	September, 10 2010
	Second Batch	4-13 Dec.

Contact Information
Full Name
Address
City
State/Province
Zip/Postal code
Country
Email Address
Mobile / Landline Number
Personal Information and Background
Education Qualification	Select Matriculation Higher Secondary Graduate Post Graduate Others
Occupation	Select Student Service Professional Business Others
Designation
Organisation
Date of Birth
Gender
Height
Weight
Emergency Contacts Name
Emergency Contacts Number
International Trips Only

Passport Number
Citizenship
Date of Issue
Place of Issue

Why you want to participate in this workshop? Explain
Filmmaking Experience (Please describe your filmmaking experience, particularly as it is relevant to the workshop for which you are registering. This information will help your mentor address your individual interests and goals as effectively as possible).
Other Interest (Please describe any other outdoor interests or personal hobbies (indoor & outdoor) that you have besides filmmaking.
Have you ever had frostbite or any other form of cold weather injury?	Yes   No
	Describe
Have you ever experienced any form of altitude sickness? Please provide detailed information on rate of ascent, altitudes, medications taken, and how the illness was dealt with.	Yes   No
	Describe
In the past two years, have you had any major accidents or illnesses?	Yes   No
	Describe
Do you have any physical limitations or medical conditions that might restrict your full participation in this workshop?	Yes   No
	Describe
Specifically, have you ever dislocated a shoulder?	Yes   No
	Describe
Do you have any knee problems?	Yes   No
	Describe
Will you be taking any medications during this trip?	Yes   No
	Describe
Do you have any known allergies to food, medications, bee stings, or other?	Yes   No
	Describe
MODE OF PAYMENT. Payment: Bank draft or Cheque. (For non –Delhi cheques, please add Rs.100 extra towards bank clearing charges). I wish to pay INR by DD/Cheque Number… dated… ………drawn on (specify bank) payable to CMS Support Services (P) Limited, New Delhi. For payment by Credit Card, pleased register online at www.cmsacademy.org.
TERMS AND CONDITIONS Participation in the workshop is subject to the following terms and condition REFUND POLICY Registration: The registration fee of INR 1000/- or (US$45) shall be refundable only if the participant is not shortlisted for the workshop. If selected, the participant will require to pay the workshop fees before the due date of the workshop. Failure to pay fees within the due date shall constitute cancellation of registration with nil refund. Workshop Fees: The Workshop fee will be refunded if the request is received 15 clear working days from the date of beginning of the workshop after a deduction of 25% as cancellation charges. No request for refund/ cancellation will be entertained, if the request is received after the above mentioned criteria. DISCLAIMER: CMS Academy and Moving Images (hereinafter referred to as Organiser) shall not be liable if the workshop is cancelled due to acts of strikes, natural calamities or any other reason beyond the control of Organisers. The Iiability will be restricted to the refund of the workshop fees after deducting expenses already incurred on organising the workshop. DECLARATION I understand that it is my sole responsibility to select a workshop dates appropriate to my mental preparedness, physical abilities and interest. I shall give a self declaration bearing the signature for the soundness of my health to undertake the workshop program. I understand that I am responsible for studying all pre-departure information, for bringing all the clothing and equipment included on the workshop equipment list for conforming the personal hygiene to minimize the risk of illness to myself and fellow participants and for acting in a manner considerate of fellow members giving due respect to the culture and religion of each other. I understand and agree that if in the opinion of organisers I fail to fulfill these obligations, the organisers may terminate my participation in the workshop without refund of fees. I understand that these conditions are set forth to protect the safety, integrity, health and success of the workshop. I have read, understand and agree to the terms of policies on cancellation and personal responsibility described above. NOTE: The registration for the workshop by the participants shall also be considered as the acceptance of terms and condition.