IK@ILflKANTA TR EIKIIKEIIR S V@ IU=UTUHI] ffi,,*,,,,!i,,m,,:,,,:3,m*.#ff ,?ff),, u,, r,, WMountaineering & Adventure Sports Foundation under Dept. ofYouth Services, Govt. ofllest Betryol) ^-^ _
Regd.No.:
frfi'Dtuuru,'r* - r, xt,it - s&, ls,e/\fr/>,'e. ilt.fr. r*fs,s-dsFot - qoooos, qFwlq s0048635or1e's1s86
Ef,gls s beeobslB:8, bbs)q\c8g8,?-mq: [email protected], g1-g4 {E} 3 www.kolkatatrekkersyouth.org
stfift >u.E €ro q>Q wffi, \o \o vt( tsiflD-q ,Rfs. , "Ipft$rs q$s ?"Efr-{R-l / mlrt+o< fu FIRr<qgqqq-6fr66*ffi f iro&fi qsfr fr rqm-{w<"rRqrqfr ruqc<t
$t<n s-{ c lv<{+ qq<inrtdq, ffi i <flfl qq<l+E4, cis$<fr{, "6ifa61fii iv 1t x,r 1B) r
alg;1-v,rFEwtfr<q{i s {1,!erBt't,[<r'8,>ir<n,ree,e|iqq1,"6q-FT1,.Irr=4,qm+,tr+i],mfc4off<ffit
"ltsTlnq1T a fiq / e{.l(Ta erfl, fi-f, / o1frfQF fl-q, flrE I
sRRi-eR wj s f,f,w srq<t r"tFq qcm EBt( {r, ori$ ( \ cqM), qrq< r<tsE, ?twcrt< 'lltt qq<rDr+{B, cqlat< qaFI F{tr]eldBr$netirB, 'll4.Nflfq({(Dffi), .5561fr-<n&(aT?fu\qrrffiFr, -6+i/fu/ tefqqtotqrmeWe-ffit<(<I{JsEf,s dn) I
clff<qc{rfr: lnmfr$m,eqcnr:r}f<,Uvo.t<,{.t.*sfi"t,qllt,"nt,"m:rem,cri@,qm-+tf<n+s<qa)ffiiarF-<fwr< &fiq (<t<i-isrqryo+rq) g ffi , {ruq qr6F, fr"tft , 1q<, cuntsirfr |
qqrfil s qtsxE uE, E6 s flBt?}, An / c<tirtB '{, ,p, WsI, cqrEFF, "tr.$E c+E 1o, c"r<, rrs, BR, {furc Q<.{, s$qrr{/ qrcr< rro/Sr+c, crffi , csqF-q, trFr?-srtfr r
o qrtdc.ls'iftcqr{qsrdc:rcn6qK?"if,1r<tq"l{srl-{"Ir{qrsl<IRNs cfr-sq{.Tf,{sRIg€r{ I
o -ttitk+stc-<trqFrt ) 8 - I a <qL<{ 6{ a+E<grr< cqrei cq({,ftfifr'r{ ({telrl{okcs "ttRr< t
o qtiB,s&, cat<trq,mmq<l,6"t-cn{6mqtfrctcarr-&wqqr,sr<frcTrcrrrEqn'irEr+rfiqqt-{$qxsd-{Frcts{rftNEtc< t
o ffidfrs{tfisxr<'l-<s&fteBrqErcvcrTRr6iqr4uqroftlqrrffs.q&iisbrcrw<--ft$ilcsrt<Fr+ts{I$Frc*c<tO q{"""""""s?l<E{{<Tt-4ft \csobfqqq r(Rcscqlegtcalrs{€e_t= \csoBfof eqm€calt-ss{Eq= qqcoDloI:llE) rqr<kr"fr€-<{ci{
qEt:o'robl+I"tibpro*c<tcc.l&cqs{, \o)b q<:m{l rw<FtE+ri-4&41ftiq-R&firs€c< t
o $il-"i $nlrsd{ w{re sM qi-{ rqm6i{ csli. 6ffi aI|. l ,laffl< <Ec< cq[E cq'erl *r< d'l r fiq1firk-< m<] 5e6a {cfiqdr ffi6Fi, cErt {kot ffi s ce$ +rt-"tt< - €E &ifr fr rls 1r+r< cns<t *r< r
o rqe 6'frcoptc-<<<tffioq{<-6qw{SrcqqiTqqqqtf,{tft<, ftE m<qgqqk= GFrcnfi{EEFCsi"\s <rlqdqlqqfiqtc< tt+ct<Ru<"tw$i6<Filr,w{sql{grcrsr uismrctqtqr{t€r<rw$tnw1t@q$(qqmFt<ffirfffitamqtffiffiWFircqtrr< r mRwEqxurrll(rt "flbm{{r<;t17 asaq{ I
o {kqlFlstft{ifusRrf,biws<({ttr{ qR<r6.ttc-qtTr{-orfier {k[s dtRrd{r cf,q s456e1c{r{K flcqtwqfrcs<i{RrE"rtRr<;rrt r ?aorbmstt<frfrh r
o fr -q q|E Frq <qq oRco dr< e<( fu q$fr e,Tfr < +Rrq wnl q{r I
ftcu:- rrdrEE eF<I<, >q?qftilil, qoqo ut({suit[s cuo> > qletdsu't (HWH)-silql(ADRA)-D@Kt{(cKe;+tt qrtIIeN
mf[rt \ssoc qtHffif $Rr< tqtE.|q( d-ns cffC(< "f<frq c\,tK ocB)G {BH r c{3'i-{ cstrs 641-ol-4 rt;46{k5t >c ftfi-ct<{C<lq-qo€
"llQrs dqr"l cfrqmtqx I c+--Brq!-saryq<R, q)?q1u-{ift, lo\o ,<lcqs+?9r{qlq=tq( cffce, m?ll-{ csl[TKls r.\sooEf{ cko)8v]B{ c<l$r$(BKSC)-E|€9I(HWH) 'll.lcqqlT({l('t<s4iqCT "lr{{frI '\qEqE$ft,{ffiK, i.oto E]( csK o8:\o rfdlTa[3st ft4cf;qr+qt
q|evi RlEet <l iEq &.ftffi <RrK q-aEffi fr-akq-{ {lTC{ 5 q / o 5 / \o 1." qfrq no \ ) srr o q$;s nat sqlrns €IEqtr<
t
{r{rTflqRfr-qqtfrrg"qtufi4tqftg"4p5q4$1-tr1eli'tqffi{q'rq.Emqal<teErd<l{CIlcrtqc.r+tot(etrs)rsHR,' q{Fq't|qlcv" (<T{tsl"I{) CTC9'ilL-fi' I
cs-{Er[m c{Ersrn s6tfrm-{ w{Icrq\sGefl.c,Ft:ql*t-qtsgi(HWH)q?(sqrD€}4lEis(Joc)vBt"l-saT{ rcssqfi-=Prt"I{(KGP)/qqtq((ADRA)qEq-qilq"iptV(Joc)*co{rgui(HWH)vlrl3-vrtt((KGp) s+qff-qnnq((ADRA)/ "turt"I{(KGP) I
c<Eemffie+isql"t-stsgt(HWH)*ToqlEIq((ADRA)sm<9ti6(KGP)qqmqfr:Yl(HWU)qk'som€9l.l_eM(Joc)qnt
<vrf eF ( KG P) \3 qtslq( (ADRA ) |
vtvq-qurq(,(ADRA)*risqleut(HWH)slnl{vrl"F(KGP)qq<lsmb€|4{v(Joc)*c\5qlsv]q((HWH)
slxt sin'qi (AD RA ) \e {V1T{ ( KGP) I
raHD-{rrfrq c+-q c+l{ frRq .{"tt elq"t sfrrq esq'ttq vRrrs rjl-"t €tu Rqfre-Trt *r<q<(TIf-4 fr csFw{?]T cr-<s cnsxt€r<ql t
APPLICATION FOR PARTICIPATION IN
35th ROCK CLIMBING TRAINING COURSE P.og,u,-.
Heldat..''''..''..'I':.v:.*l.1i.I:}.l.l.*::Ji::w..-":1B.1g:1'...............Starting from 18.01.2020, Saturday To 21.01.2020, TuesdaY
l. Name Mr./Mrs./Miss
(Full name in block letters)
2. Father's/ Husband's name ..........
4. Sex .................. 5. Date of birlh 6.Telephone No .."""""" "'(Resi')
8. Occupation 9. KTY Membership No .'.........."
10. Designation & Office address
11. Previous experience of similar activities (attach a seperate sheet if needed) ............"
12. Vegetarian/Non-Vegetarian ....... 13' Hobby
14. Next of kin (Relationship, Name & Address with Tel. No.) ...-.'....'
15. Equipments/articles which shall be issued by the Club will be returned within two days from the date
of arrival at Kolkata or as may be decided by the Course Leaderl Organiser, failing which I shall pay
maintenance charges as per Club's rules.
16. I will write the daily diary during the programme and will surrender it to the course leader after the
programme is over.
I, ................. ....agree to adhere strictly to the discipline of the
programme ancl abicle by the directions-of the organisers at all times during the programme.
In case of any accident, illness or injury, I will not hold the any other parlicipants,course-conducting
committee, instructors or course leader of Kolkata Trekkers Youth or its members responsible in
any way during the arrival & departure for the same and also during the programme period.
I am sending the parlicipation fee of Rs. .,................ by M.o/cash/Bank Draft No .'............
Dated.........
I have the following equipment to be used for this programme : """""""""
Signature
PARENT'S/GUARDIAN'S CONSENT(To be filled in by those under 18 years of age)
!t is certified that my son/daughter/ward Mr./Mrs./Miss.........
isjoining35th ROCKCLIMBINGTRAININGCOURSE programmewith myconsent.ln case
of any accident, illness or injury, I will not hold the other participants, course-conducting
committee, lnstructors or course leader of Kolkata Trekkers Youth or its members
responsible in any way during the arrival & departure for the same and also during the
programme period.
Signature of parent/guardian
(Relationship with the applicant)
FOR OFFICE USE ONLY
1. Date of receive of application ...........,.
2, Received Rs. ..,...... .... Vide Receipt No............. .Dated
Conflrmation sent on .............
3. Certificate's Roll No. KTY/ B/ I 20 I / 35th Dated
4. Grading (............ .........)
5. Graduation Ceremony held at
6. Remarks:
on 2020