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ST.

XAVIERS SCHOOL, HAZARIBAG


DIAMOND JUBILEE YEAR 2011-12
Alumni/ Alumnae Reunion
26-28 January 2012

REGISTRATION FORM
Name:...................................
Surname

Gender:

Male

.......... .............................

......................................

First Name

Female

Middle Name
(Tick One)

Name of Spouse:...............................................................

No. of Children:....................
[If spouse and children will be attending]

Year of Leaving the School: ...........................


Correspondence Address: ...........................................................................................................
.................................................................................................... Postal Code:..........................
Phone No: ................................................. Cell No: .............................. ...............................
Email: .........................................................................................................................................
Occupation: ................................................................................................................................
Food Preference: Vegetarian

Non Vegetarian

(Tick One)

Arrival:

Date:........................................ Time: ........................................................

Departure:

Date:........................................ Time: ........................................................

Payment Details: DD/ Cheque No................................................ Date ............................. for


Rs.................................................... Drawn on .......................................................... Bank
(Payable at Hazaribag)

[For those who wish to make a direct bank deposit AXIS Bank a/c. No. 910010027445252
Date of Making the Deposit:........................................... Please send the payment slip along with this form]
.................................
Date

...................................
Place

.......................................
Signature

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