Nexsis Core

PARTICIPANT'S REGISTRATION FORM (ATI)

Instruction: Please fill up all the information asked. Write NONE where applicable.

TRAINING

Training/Activity *

Name *

Civil Status *

Birthdate *

Age

Occupation/Position/Designation

Highest Educational Attainment

Degree

PRC Registration No. / Valid Until

Profession

Farmer ID No. (RSBSA/NCRFS)

Agency

Office Address

Contact Number

Email Address

Region *

Province *

City/Municipality *

Street *

Barangay *

DIETARY RESTRICTIONS

Vegetarian

Non-pork

Allergies on

Others (please specify)

HEALTH CONSENT

I am physically fit to travel and attend the training/activity.

I am physically fit to participate in the activities which may require field work and hands-on.

Privacy Statement

The Agricultural Training Institute (ATI) is committed to protect and respect your personal data. We recognize our responsibilities and our data subject's right under the Republic Act No. 10173, also known as the Data Privacy Act of 2012.

Privacy Consent

I have read and understand the Institute's Data Privacy Statement and express my consent for ATI to collect, store, use, share, process and update my personal information.