Alumni Registration Form
Name
First degree from HBTI Kanpur
Degree
Discipline
Year
Other degrees from HBTI Kanpur
Degree
Discipline
Year
Present Position and Address
Designation
Organization
Address
City
State
Country
Code
Phone
Fax
Mobile
E-mail
Residential Address
Address
City
State
Country
Code
Phone
Fax
Mobile
E-mail
Permanent Address
Tick here if same as residential address
Address
City
State
Country
Code
Personal Information
Date of Birth
Wedding Date
Name of Spouse
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Alumni Life Membership Fee of Rs.1000/- by Cash/Cheque or DD drawn in favour of
"Alumni Association, H.B.T.I., Kanpur" on
with Cash Receipt No.
,
Cheque /DD No.
,
Bank Details
.