KERALA THROWBALL ASSOCIATION® Affiliated to: Kerala State Sports Council & Throwball Federation of India Recognised by Ministry of Sports & Youth Affairs, Govt. of India Regd. Off: c/o. Yacca Sports, Yacca Building, Amaravathy Jn., Fort Kochi, Ernakulam. CLUB REGISTRATION FORM – ERNAKULAM (TO BE FILLED IN CAPITAL EXCEPT EMAIL) Registration Type Type New School Reinstated (break in affiliation) college institution Name of the club : Address of the Club with pin code : Renewing(no break) Club Pincode: Club email if any : @ Phone No. of the club with STD code : Name of the HM/Principal/President : Mobile No. : 1 email address : Name of the HOD, PET, Secretary : Mobile No. : 1 email address : Name of the Treasurer : Mobile No. : 1 email address : Registered under Society Act? if yes, registration No. with dt. If No, attach 2 sports person’s ref (attach add sheet) : Reg. fee of Rs. 500+……… paid through Cash Extn: 2 @ 2 @ 2 @ Bank payment online transfer cheque/DD Details ………………………………………..…………………………………………………………………………… Office seal Signature of the Principal / H M / President File No : Reg. form received on : Photo of the club secretary / PET/HOD Signature of the PET / HOD / Secretary Through : Application form Resolution copy of club meeting : : attached / not attached attached / not attached (only for clubs) Additional Papers attached : 1. ………………………………………………………… 2. ………………………………………………………… Approved/Rejected (reason if rejected) : Approval/Rejected meeting details : Registration Code : Sign of the Dist. Sec. with date and seal :