KATHMANDU UNIVERSITY ROBOTICS CLUB

(KURC)
Kathmandu University, Dhulikhel, Nepal
email: kurc@ku.edu.np, website: www.ku.edu.np/kurc

MEMBERSHIP FORM
Form No.:
* These fields are compulsory

[1]. LAST NAME* MIDDLE NAME

FIRST NAME*
PP size photo

[2]. DEPARTMENT *
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[3]. LEVEL YEAR *

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[4]. CONTACT NO.*

[5]. ADDRESS
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[6]. EMAIL ADDRESS*

…………………………… @ Gmail Yahoo Hotmail Student.ku.edu.np
Others(Specify)…………….....

[7]. How do you often take part in events organised in your school/college/university/community.***
Executive Organizer Organizing Volunteer Participant
Audience/ Observer Judge/ Evaluator Trainer/ Instructor

[8]. What types of membership do you want in this club?*

General Member Executive Member** Advisory Member**
[9]. Which fields of robotics and technology are you interested in? ***
Electrical Electronics Mechanics Computing
Mechatronics Artificial Intelligence Embedded Systems

Sensor Systems Automation Robotics

Adaptive Control Aerial Robotics Humanoid

Software Internet of Things Programming

Aquatic Robotics Space Science Modular Robotics

[10]. List some main technology related events/ programs/ competitions that you have previously
participated.

Submission of this form provides general membership by default

** Executive and Advisory membership needs further documentations
*** Choose one or more suitable options
 Event Name Date (Year) Organised By

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[11]. List some of the projects that you have previously done (if any).

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[12]. List any five major activities that KURC should do.

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[13]. Required documents * Applicant's Signature*

KU ID card Photocopy-1
Passport sized photos-2

I agree to follow the code of conduct defined by KURC*

KURC OFFICIAL USE ONLY

NAME:

KURC REG ID: MEMBERSHIP:

APPROVED BY: APPROVED DATE: