KSHETRAKALAVIDYAPEEDAM
PERUVAYAL
PROUDLY PRESENTS
ON 2015 MAY
1,2 AND 3
Application form
Name of the Troupe :
Name of the Troupe Leader :
Address :
District :
State :
pin :
phone (land line) :
Mob. :
No. of participants in the troupe :
Troupe manager :
Contact address :
phone number :
any other contact no. :
Mode of registration : Direct / E-mail
Mode of registration fee paid: Direct / thorough bank counter
(if paid through bank counter E- mail the receipt scan copy to us)***
(if paid through bank counter E- mail the receipt scan copy to us)***
Troupe need any thing on background other than colour
light : yes / no
If yes which one do you want : curtain(s) /
video projector / LED display *
Troupe need accommodation in kozhikode city :
yes /no **
If yes, affordable rate of the room in between
:₹ to ₹
(* Background other than colour light is not
resposible for the organisers
** Organisers book the room(s) if you wish and not
responsible for the rent or comforts in it.
***Reg. fee ₹ 5000 can pay in favour of Kshethrakalavidyapeedam Peruvayal payable at SBI poovattuparamba, SB no. 34808161583, ifsc code is SBIN 0012195 )
***Reg. fee ₹ 5000 can pay in favour of Kshethrakalavidyapeedam Peruvayal payable at SBI poovattuparamba, SB no. 34808161583, ifsc code is SBIN 0012195 )
(N.B. Read Terms and Conditions before filling the application form)
contact no.s 9446339516,
9847098399, 9447454314, 9447245179
EMAIL: kshethrakalavidyapeedam@gmail.com
Dance troupe members
Sl. No. Name m/ f Age Address with phone no.
Dance troupe members
Sl. No. Name m/ f Age Address with phone no.
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team manager:
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team manager: