Alumni Membership Form

Membership Form for The Durgapur St.Xavier’s School Alumni Association

(Regd under W.B Act XXVI of 1961 vide No. S/1L/86140 of 2011-12)

Name: _______________________________________________________Batch___________

Email:________________________________________________________________________ (Please provide a personal mail id and not an office mail id)

Contact no.:(M)__________________________(Landline with STD code)_________________

Current Address:______________________________________________________________

______________________________________________________________________________

Permanent Address: _____________________________________________________________

______________________________________________________________________________

Professional Info: Organisation____________________________________________________

 Stationed at ____________________________Designation_____________________________

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To

The Secretary

The Durgapur St.Xavier’s School Alumni Association

St.Xavier’s School, Bidhannagar, P.O. A.B.L Township, Durgapur 713206

Dear Sir,

Please enroll me as a Member of The Durgapur St.Xavier’s School Alumni Association. The information I have provided in the form above regarding myself is true to my knowledge and belief. I have enclosed a cheque/demand draft of Rs3000/=[kindly add Rs50/= for out station cheques] towards membership, payable to The Durgapur St.Xavier’s School Alumni Association, bearing number_______________dated _________, drawn upon ___________ _____________________________________________________payable at Durgapur.

Thanking you,

Yours faithfully,

________________________________                            Dated:___________________

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For Office use only:

Date received on: _________Received by: _______________Membership No.______________