Please mail to:

ALL KERALA RIVER PROTECTION COUNCIL,
Register No. 1052/99,
Ramapriya,
High Road,
Aluva-1.
Kerala - 683101,
India.

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APPLICATION FOR LIFE MEMBERSHIP


 
1. Name (in Capital Letters)  : 
2. Address,
Residence
(with pincode)		 : 
3. Telephone Number (Residence
& Office)		 :
4. Fax Number  :
5. Email :
6. Age :
7. Educational Qualifications :
8. Occupation (latest) :
9. Areas of Interest :
10. Name and Address of the
member who is recommending
(with signature)		 :
11. Recommendation :

Declaration
I, ...................................................... hereby declare that I shall abide by the existing and future rules of All Kerala River Protection Council and shall act for achieving the objectives of the Council.
 
 
Place: Signature:
Date:

For office use only
 
Admitted: Receipt No:
Date :