ALUMNI ASSOCIATION OF SHRI SHIVAJI SCIENCE COLLEGE

AMRAVATI

Address: Shri Shivaji Science College, Morshi Road, Amravati

Application Form For Membership

To,

The Secretary,

Alumni Association of

Shri Shivaji Science College, Amravati - 444603

Dear Sir,

I would like to be enrolled as a member if "Alumni Association". I have paid Rs. 500/- (Rupees Five Hundred only) against my life membership subscription on dated      /     /          vide receipt no. dt. ______________

My personal information is given below:

1

Full Name (in BLOCK letters)

:

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:

SURNAME           FIRST NAME       MIDDLE NAME

2

Date of Birth

:

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3

Educational Qualification

:

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4

Year of passing from this college

(Please indicate XII/ B.Sc./ M.Sc.)

:

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5

Present status (Employed/ Business)

(Give designation if employed)

:

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6

Official Address

:

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7

Address for Correspondence

:

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8

Phone No. and email

:

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9

Any Significant Achievement

:

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10

Please give three names of your classmates and their present addresses

:

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