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Application Form for Registration of NRK Association Abroad NORKA-ROOTS Norka Centre Near Govt. Guest House Thycaud Thiruvananthapuram 695014 Phone 91-471-2332416 / 2332452 Fax 91-471-2326263 e-mail mail norkaroots. Net URL www. norkaroots. net Country Place Name of Association in BLOCK Letters Date of Formation Address for Communication ZIP Code Tel. 1 with STD code Website Name of President Tel. Mobile Name of Secretary Fax with STD code e-Mail Details of Institutions being run under the Association/ Main activities of the Association OPTIONAL How would you like to associate with NORKA-ROOTS/NORKA Department/ Government of Kerala Issues that your Association wants to draw the attention of NORKA-ROOTS/ NORKA Department/ Govt. of Kerala concerning Malayalees abroad No. of members enrolled. Name Signature President Secretary Treasurer 1. This web based registration may be followed by sending a hard copy of the information furnished above in the same format. 2. Names and details of the members enrolled with their e-mail id and signature may also be sent. 3. Registration numbers will be provided only after furnishing the above said information*4. This information would be used for long term policy formulation in the field of welfare and rehabilitation of Keralites outside India*5. This information would be essentially used as a research input and would not be used for any other purposes other than official and wouldn t be parted with any other source other than official* FOR OFFICE USE ONLY Signature of Registering Authority. This web based registration may be followed by sending a hard copy of the information furnished above in the same format. 2. Names and details of the members enrolled with their e-mail id and signature may also be sent. 3. 2. Names and details of the members enrolled with their e-mail id and signature may also be sent. 3. Registration numbers will be provided only after furnishing the above said information*4. This information would be used for long term policy formulation in the field of welfare and rehabilitation of Keralites outside India*5. Registration numbers will be provided only after furnishing the above said information*4. This information would be used for long term policy formulation in the field of welfare and rehabilitation of Keralites outside India*5. This information would be essentially used as a research input and would not be used for any other purposes other than official and wouldn t be parted with any other source other than official* FOR OFFICE USE ONLY Signature of Registering Authority. This web based registration may be followed by sending a hard copy of the information furnished above in the same format. 2. Names and details of the members enrolled with their e-mail id and signature may also be sent. 3. Registration numbers will be provided only after furnishing the above said information*4. This information would be used for long term policy formulation in the field of welfare and rehabilitation of Keralites outside India*5. .

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