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Indian Institute of Management - Kozhikode

Sangam 17 Alumni Registration Form

1. Name : ___________________________________________________________________
2. Batch / PGP: _____________________________________________________________
3. Organization: __________________________________________________________
4. Designation: ____________________________________________________________
5. Current Address:
____________________________________________________________________________
____________________________________________________________________________
6. Nominate for City Chapters as P.O.C. (Yes/No): _____________________
7. City Chapter to associate with: ______________________________________
8. Contact Number(s): _____________________________________________________
9. Email Address: ___________________________________________________________
10. Signature: ____________________________________________