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Kerala Renewable Energy Entrepreneurs' & Promoters' Association (KREEPA)
Regd Off : Renewable Energy Centre Mithradham, Chunangamveli, Aluva, Ernakulam District, Kerala PIN 683 105

PAN no:

DELEGATE REGISTRATION FORM

Please make payment as per the selected delegate category on the previous page, fill in the below application form along with UTR and bank details and click submit to complete registration. You will receive a confirmation from us once payment is verified with details provided. Students to check with our contact number prior to registration for seat availability

Name of the Deligates General Student Tick dates registered Amount
24 25 26 Tot
*Students are required to produce the nomination letter from the Principal/HOD to avail concession TOTAL
Please tick as applicable Entrepreneur Employee Consultant Academic Customer
Renewable Electrical Govt. Industrial Teaching
Have you attended any KREEPA event earlier? Yes No Are you referred by somebody? Yes No
Name & Address of the Institution / Individual
Email ID
Telephone
Mobile
In case of students; nominated by Name
Designation
Name of the College
College Seal
Payment Details (Please refer UTR of NEFT/RTGS) Amount: Bank:
UTR ref: Date:

Bank details for NEFT/RTGS

Beneficiary Name Kerala Renewable Energy Entrepreneurs and Promoters Association
Beneficiary Bank Federal Bank Ltd, Kaloor Branch, Kochi - 682 017
A/c No 142 101 000 34569
IFSC code FDRL 0001421
Date
Name
Signature