Alumni Association Membership Form

NEHRU GRAM BHARATI (DEEMED TO BE UNIVERSITY)

Registration Number.

PERSONAL DETAILS


Full Name:

Father’s Name:

Postal Address:

Occupation:

Ph: Residential

Office:

Mobile Number:

Email Address:

DEGREE DETAILS:


Enrolment Number:

Name of Examination:

Department:

Session of Examination:

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Magazines/Newsletter

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Alumni Membership Card

Annual (Rs. 100)/Lifetime (Rs. 500)
Cheque/Pay Order/ Bank Draft / DD No.

Dated


Bank

Branch

Amount: (Rs.)

I hereby apply for the Membership of the Nehru Gram Bharati (Deemed to be University), Alumni Association for which I am eligible. Requisite Membership fee (bank draft/Demand Draft/Pay Order) has been paid in favor of Nehru Gram Bharati University payable at Prayagraj, Uttar Pradesh. My particulars are given above. In case of any change, I shall intimate the same. I have read the constitution of the Association and agree to abide by it.

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