Name
:
..
APPLICATION FORM
No 2 IMF HIGH ALTITUDE &
MOUNTAIN MEDICINE COURSE 2008
Name
:
..
Date
of birth/ Age
:
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Address
:
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Tele
No
:
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Fax
No.
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E-mail
:
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Whether
Employed
: Yes/No
Name
of the Organisation :
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Designation/Rank
:
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Address
(Office)
:
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Professional
Qualification :
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Mountaineering
& Allied Qualification:
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S
No |
Course |
Institute |
Course
No/ Month
& Year |
Grading |
Remarks |
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(a) |
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(b) |
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(c) |
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Mountaineering/
Trekking Experience: Most Recent First
|
S
No |
Year
& Name of Expedition |
Peak
(Ht) & Route |
Height
Reached |
Remarks/ Any
Other Info |
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(a) |
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(b) |
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(c) |
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(d) |
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Course
Fee Remittance Details :
.
..
CERTIFICATE
I,
Dr________________________do hereby volunteer to undergo No 2 HAMR Course at Leh.
I
am physically and medically fit to travel to high altitude and undergo training. In case of any injury (including fatality)
arising on account of any accident or mishap during the course or
travel undertaken in conjunction with the course , no claim, whatsoever
would be raised against the IMF.
Date
:
(Signature of the applicant)
MEDICAL
CERTIFICATE
I have
examined Dr________________________________(Date of birth__________________)
on________________(date) at
________________________(place).
I
consider him/her fit for travel to
high altitude (more than 9000 ft) to attend High Altitude & Mountain
Medicine Course at Leh, Ladakh.
Date
:
(Signature
of Doctor)
Full
Name : ______________________________________
Regt No :
______________________________________
Medical Council
with
which Registered.
____________________________________
HIGH
1.
Indian Mountaineering Foundation (IMF) is the apex organization that
controls and supports mountaineering and allied activities in
Course
Over-view
2.
This will be second course being organized by Indian Mountaineering
Foundation. The first course was organized in the month of Jul 2007 at
3.
The course proposes to fill the vacuum in the training of mountain and
high altitude medicine in
4.
The course has been designed to cover the various aspects of high
altitude, human physiology, peculiarities of survival at high altitude, high
altitude illnesses and rescue in high altitude etc.
5.
A tentative list of subjects to be covered:
|
a) |
High altitude |
-peculiarities of high places including
weather at high altitude |
|
b) |
Effects of
environment |
-cold, heat and solar radiation injuries |
|
c) |
Human physiology
at high altitude |
|
|
d) |
Altitude illness |
|
|
e) |
Medical/surgical emergencies at
high altitude |
|
|
f) |
Traumatology |
|
|
g) |
Rescue-organized/improvised |
|
|
h) |
Medical plan for
expeditions |
|
6.
The course will be delivered in English.
Course material with course presentation will be provided to all
participants of the course.
7.
The instructors will be drawn from pool of experienced/qualified doctors
who have vast experience of working in high altitude environment.
Participants
8.
The target group for the course is all the doctors who have active
interest in the field of mountaineering, trekking and other associated high
altitude activities, those who by virtue of their employment are working in high
altitude areas and all those who plan to / will accompany an expedition to high
altitude.
Duration
9.
The course will be conducted at Leh. The duration of the course is 8 days
from 07 to 14 Sep 2008. The participants are expected to report latest by 06 Sep
2008 (AN).
Fee/Charges
10.
All participants / their sponsors will be required to pay a nominal
amount as registration fee of Rs 2000/- per participant. In case of civilian
participants this fee will be refunded in case they volunteer to join as Doctor
in any IMF sponsored expedition after completion of the Course.
11.
Candidates will have to travel to Leh and back at their own / sponsors
expense.
12.
The boarding and lodging at Leh and local travel on account of training
will be borne by IMF.
Certificate
13.
All participants will be evaluated at the end of the course and the
successful participants will receive Course Certificate.
Contact Information
14.
Any queries can be addressed to: -
Director
Indian
Mountaineering Foundation
6,
Tel:
011- 2411 1211/2411 7935
Fax:
011-2411 3412
E-mail:
indmount@bol.net.in