Alumni Association

Membership Form

TO,

THE SECRETARY
Alumni Association
University of Agricultural Sciences
Hebbal, Bengaluru- 560024

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Dear Sir,

I hereby apply for admission as Life Member/Associate Member/Institutional Member of the Alumni Association, University of Agricultural Sciences, Bengaluru. I Graduated from the College of

In The Year

by obtaining degree of

I have read the constitution and rules of the Association and agree to abide by them, if admitted.

* I am enclosing herewith a Sum of Rs.

in Cash / DD No

dated

being the Membership Fee.

* I have already paid the membership fee of Rs

through UAS, Bengaluru vide

SL. No

ID No.

of College of

for the year

under student category.

APPLICANT'S PARTICULARS

Full Name		DOB
Address	Office	Residence
Address	Street Street 2 City State Postal/Zip Country	Street Street 2 City State Postal/Zip Country
Correspondance Preffered
Phone Number	Office	Residence	Mobile
Phone Number
Email Address	Email Id	Alternate Email
Email Address
Name of Proposer		Signature of Proposer

Social Media Details

Website

Blog Name

Linkedin

Facebook

Twitter

Note:

*New Members shall pay the applicable fees only after approval of membership by the Secretary, Alumni Association.

1. Life/Associate Membership fee Rs. 500/- +Entrance fee Rs. 10/-
2. Institutional Memnership fee Rs. 5000/- +Entrance fee Rs. 10/-
3. Enclose two Passport size Photographs

Verification

Please enter any two digits*

Example: 12

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APPLICANT'S PARTICULARS

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