M.B.M.

ENGINEERING COLLEGE ALUMANI ASSOCIATION

ALUMANI BUILDING, V. G. GARDE MARG, JODHPUR 342011 EMAIL: mbmalumni@yahoo.com Web: mbmalumni.org Tel: 91-291-2513121 Fax: 91-291-2741721

APPLICATION FORM FOR ORDINARY / LIFE / FELLOW / PATRON MEMBERSHIP

To, The Honorary Secretary, M.B.M. Engineering College Alumni Association, JODHPUR. Dear Sir, I wish to become ORDINARY / LIFE / FELLOW / PATRON member of the M.B.M. Engineering College Alumni Association. The details of myself are as under: 1. 2. 3.
4.

NAME YEAR OF GRADUATION BRANCH PERMANENT ADDRESS

(Where correspondence is to be made Permanently)

: : : :

Year

Post Graduation

Pin Code State Country STD Code

TELEPHONE NO:
5.

PRESENT RESIDENCE ADD.

:
Pin Code State Country STD Code

TELEPHONE NO:
6.

PRESENT OFFICE ADD.

Pin Code State Country STD Code

TELEPHONE NO:
7. 8. 9. 10. 11. DESIGNATION FAX NUMBER MOBILE NO E-MAIL ADDRESS PROFESSIONAL STATUS : : : : :

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M.B.M. ENGINEERING COLLEGE ALUMANI ASSOCIATION

ALUMANI BUILDING, V. G. GARDE MARG, JODHPUR 342011 EMAIL: mbmalumni@yahoo.com Web: mbmalumni.org Tel: 91-291-2513121 Fax: 91-291-2741721

I am enclosing here with a cheque /Draft/ Cash/ of Rs. .towards the subscription fee bearing Cash/Cheque / Draft No. ..Dated..payable at Jodhpur drawn in favor of M.B.M. ENGINEERING COLLEGE ALUMNI ASSOCIATION. Kindly accept my application and enroll me as (Ordinary / Life / Fellow / Patron Member). I also further wish to undertake the declaration and agree to further its aim and objectives, and shall abide by its constitution, rules and regulations. Date : Place :

Membership Category Amount R No Date

NOTE:
1. 2. a) b) c) d) 3. a) b) c) d) e) 4. Please fill up form carefully and neatly in capital letters. Present membership fee for various categories of membership are as under. Ordinary Membership : Rs 200/for 5 years for New Passed outs. Life Membership : Rs 2000/or US$ 200 for NRI Fellow Membership : Rs 5000/or US$m500 for NRI Patron Membership : Rs 21000/or US$ 1000 for NRI Profession codes are as under: Business Man Teaching Faculty Govt Services Private Services Retired Every member shall be informed with his membership number and code number.

5. Kindly intimate immediately for any changes in the information / address.

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