Non Resident Keralite Directory

1.	Name
2.	Gender	Select One Male Female
3.	Date of Birth	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
4.	Present Address
	House Name
	Street
	State / Province
	Country
	Postal / Zip Code
	Telephone
	Fax
	E-Mail
	Web
5.	Education	Select One Post Graduation and above Graduation School/HSC Other
6.	Occupation	Select One Executive/Management Professional(Doctor, Engineer, lawyer etc.) Academic/Education Software Professional Accounting/Finance Service/Customer Support Clerical/Administrative Sales/Marketing Tradesman/Craftsman Student Self employed Retired Unemployed Other
7.	Address in Kerala (Please provide pincode)
	Telephone
8.	Number of years as a Non Resident Keralite
		Select One Less than 1 year 1-10 Years 10-20 Years 20-30 Years Above 30 Years
9.	Is your family staying along with you
		Yes No
10.	How often do you visit Kerala
	Year	Number of Times
	Select One Less than 1 year 1-3 Years 4-6 Years 7-10 Years Above 10 Years	Select One 0 1 2 3 4 5 6 7 8 9 10
11.	Average duration of your stay in Kerala
		Select One Less than 30 days 30-60 days 60 -120 days 120 -180 days More than 180 days
	Yes, I am interested in subscribing to the monthly pravasi e-mail newsletter of NORKA.

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