Application Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" bgproperties="fixed" background="08c285a1erlcgo.gif"> <div> <FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>MAITHILI</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="MAITHILI"><U><B>home</B></U></A></div> <div> <A HREF="id43.htm" TARGET="_top" TITLE="Terms and Conditions"><U>Terms and Conditions</U></A>   |   <B>Application Form</B></div> <div> <A HREF="maithili.htm" TARGET="_top" TITLE="Maithili Language : an introduction"><U>Maithili Language : an introduction</U></A>   <A HREF="questions.htm" TARGET="_top" TITLE="Current Concerns"><U>Current Concerns</U></A>   <A HREF="profile.htm" TARGET="_top" TITLE="Author Profile"><U>Author Profile</U></A>   <A HREF="works.htm" TARGET="_top" TITLE="Works "><U>Works </U></A>   <A HREF="songs.htm" TARGET="_top" TITLE="Folk Songs"><U>Folk Songs</U></A>   <A HREF="review.htm" TARGET="_top" TITLE="Book Reviews"><U>Book Reviews</U></A>   <A HREF="links.htm" TARGET="_top" TITLE="Links"><U>Links</U></A>      <A HREF="id42.htm" TARGET="_top" TITLE=" Prizes"><U> Prizes</U></A>    <A HREF="contact.htm" TARGET="_top" TITLE="Contact"><U>Contact</U></A></div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="08bd2c00dkelyh.gif"> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Application Form</I></div> <div> <I><B>This form should be printed and sent by registerd post along with the material for entry and MO fo Rs. 30.00 (Rupees Thirty Only) in the name of '</B></I><B>Maithili Pratibha</B><I><B>' to the </B></I><FONT SIZE="2" COLOR="#0099FF" FACE="Arial" ><A HREF="contact.htm" TARGET="_top" TITLE="Contact"><U><I><B>contact address</B></I></U></A></FONT></div> <bR> <bR> <div>      Serial No.( To Be Filled By The Organiser)</div> <div> 1. Name of the applicant:</div> <div> 2. Age:</div> <div> 3. Postal Address:</div> <div> 4. Category (Tick One) : Yogmaya Smriti / Rameswar Smriti </div> <div> 5. Type of applicant  (Tick One) : Enlightened reader / Writer / Publisher / Collector of materials.</div> <div> 6.The published material is(Tick One) : Complete book / Partial Work / Whole magazine</div> <div>    a.If it is a book,  Name of the book:</div> <div>        Author with full address:</div> <div>        Year of publication:</div> <div>        Publisher's name and Address:</div> <div>        Is the complete book publised in a single issue of a magazine:</div> <div>        If so, the name, number and year of publication of the magazine:</div> <div>    b. Is it a (Tick One) complete magazine / part of a magazine?</div> <div>        The name, number and year of publication of the magazine</div> <div>        Editor's name</div> <div>        Publisher's name</div> <div>     c. Is the work complete/partial</div> <div>         No. of pages</div> <div>         Which magazine's part</div> <div>         Which number and issue</div> <div>         </div> <div> 7. Please mention in about 200 words ( in english or in maithili) the significance of the entry.</div> <div> 8.The enclosed material is of .......... pages. Iam sending this material of my own free will and in future will not request its return.</div> <bR> <div>                                                                                                                                      Applicant's Signature </div> <div> Date and Place        </div> <bR> <div> <FONT SIZE="2" COLOR="#000000" FACE="Arial" >                                                       </FONT><A HREF="id42.htm" TARGET="_top" TITLE=" Prizes"><U> </U></A><A HREF="id42.htm" TARGET="_top" TITLE=" Prizes"><U><B>prizes</B></U></A><A HREF="id42.htm" TARGET="_top" TITLE=" Prizes"><U>  </U></A>                   <A HREF="id43.htm" TARGET="_top" TITLE="Terms and Conditions"><U><B>Back</B></U></A>        <FONT SIZE="3" COLOR="#0099FF" FACE="Arial" ><A HREF="id49.htm" TARGET="_top" TITLE="AWARDS"><U> </U></A><A HREF="id49.htm" TARGET="_top" TITLE="AWARDS"><U>Next</U></A></FONT></div> </td> </tr></table></body>