LIFE MEMBERSHIP ENROLMENT FORM Cw The Hon. Secretary J.T], ALUMNI ASSOCIATION Next to Textile Hall at VITI, H. R. Mahajani Marg, Matunga, Mumbai 400 019 od |, the undersigned, wish to enrol myself as a Life Member of VJTI Alumni Association. undertake to abide by the Constitution, Regulations and Bye-laws of the Association. Cash/ Cheque / DD No. J NEFT dated drawn on, Bank for Rs, J- in favour of VITI Alumni Association is enclosed. sumame First Name Middle Name Mr] Mesh] BAT ATHARYA ACHILASH ‘Address (Residence) + BA, Rohit Residency — Kotana \Wasohot Vasad 415529 ~ goteda, Mohowoshwa ‘Address (Permanent) » Bi. Ronit Residency Koyama Versohost Yara, 416539 sokeed, Muhosnshtog | Telephone No, (Residence) : = —~ (Office) :$__ (Mobile) : _A8SO4R4BE0_ / B20833S2)6F E-mail : _adhasvapotl@ zohomallin Name of Company / Employer : Designation : STUDENT Address (Company/Employer) :_=— Batch (Year of Passing) : 9022 Branch: _CIN(C Enginessine\ Course (Please tick ¥) : a Begree 0 Diploma O Others D Post-Graduate OD Ph.D. Date of Birth : __2¢/05"] 2000 Marriage Anniversary: = Nationality: INOIAN PAN No. (If Indian): EkGppisioP Passport No. (If NRI) : = can support Alumni Association as follows: 1, Take Special Classes and arrange Factory Visits for current students 22 Help Mentoring Entrepreneurs 3. Support in placing Students for Intemship 4. Obtain Advertisements for Vaijayanti and Donations. 5 ‘Any Other: (PL. specify | hereby permit the Association to credit my subscription to its CORPUS FUND. Signature of the Applicant: Please Turn Over for details of mode of payments