Indian Mountaineering Foundation

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Liaison Officer | IMF

LIAISON OFFICER APPLICATION FORM

Basic information

First name:*

Last name:

Date Of Birth:*

Father's Name:*

Email:*

Academic Qualifications:*

Phone Number:*

Permanent Address(Line1):*

Permanent Address(Line2):*

City:*

Pincode:*

Whether Correspondence address is same as permanent address:*

Yes No

Correspondence Address(Line1):*

Correspondence Address(Line2):*

City:*

Pincode:*

Whether Employed:*

Yes No

Organization Name:

Designation/Rank:

Gross Monthly Income:

Office Address(Line 1):

Office address(Line 2):

City:

Pincode:

Next of Kin Details

Next of kin's name:*

Relation with the applicant:*

Address(Line 1):*

Address(Line 2):*

City:*

Pincode:*

Photograph and signature upload

Upload Photograph*

(jpeg,png and gif only,max 1 MB)

Upload Signature*

(jpeg,png and gif only,max 1 MB)

Other details

Mountaineering and allied qualifications:

0
Course	Institute	Course No	Month & Year	Grading	Remarks

Mountaineering Experience Most Recent Expedition First:

	Name of Expedition	Year of Expedition	Peak(Ht) & Route	Summit/Height Reached(Meters)	As LO Yes/No

Preferred season.* Pre-Monsoon Post-Monsoon Both

Preferred months:* to

Preferred peak:*

Reason for preferred peak:

Height(in cms):*

Climbing boot size:*

US EU

I agree to the following:

(a)The above information given by me is correct to the best of my knowledge and belief.

(b) I am medically fit for mountain climbing above 6000 Mts. (20000ft approx).

(d) I have never been convicted in any police case.

Declaration

I hereby volunteer to undertake LO duties as detailed by IMF. In case of any injury (including fatality) arising on account of any accident or mishap during the expedition or during training/ travel undertaken in conjunction with the discharging of the said duties, no claim, whatsoever would be raised against the IMF.