Application Form for Registeration

PAKISTAN NUTRITION AND DIETETIC SOCIETY

REGISTERATION EXAM

Application Form for Enrolment for Registration Exam as Human Nutrition Professional (Dietitian and Public Health Nutritionists)

Note: Please complete all sections and enclose the following with your application. (Incomplete applications will not be processed).

1.Curriculum vitae
2.Attested copies of educational qualifications
3.Certificate/letter documenting at least six months experience in dietetic nutrition related profession.

SECTION 1

Personal Details:

Full Name: (As you wish it to appear on your certificate)
Date of Birth:	dd: mm: yyyy:
Gender:	Female Male
Title:	Dr Mrs. Miss Mr.

Mailing Address:

Address:

City: Province: Postal Code:

Phone: Mobile:

Email:

For official use only

To be filled by authorized members of PNDS accreditation committee

Applicant is eligible for taking the Registration Test: Yes No

If yes, then under which category: Dietitian Public Health Nutritionist

Name_______________________________ Name______________________________

Signature____________________________ Signature____________________________

SECTION 2

Relevant Academic Qualifications: (Start with the most recent)

Year of Award	Name of Degree	Name and Address of Awarding Institution

SECTION 3

Relevant Practical Training/Experience: (Start with the most recent)