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Potti Sriramulu Chalavadi Mallikarjunarao

College of Engineering & Technology 


Department of Electronics and Communications Engineering
ALUMNI REGISTRATION FORM

Name:

Father’s name: Affix


Passport photo
Date of birth: (DD/MM/YYYY)

Gender: MALE / FEMALE

Degree: B.Tech

Branch: ECE

Year of passing

Marital status: YES / NO

Telephone no:

Mobile no:

E-mail ID:

Current address: Permanent address:

Details of Higher Studies, if applicable:

Course Name:

Specialization:

University:
Address:

Work Information:

Employer:

Job designation:

Office phone no: Official email:

Field of work:

Details of Entrepreneurship, if applicable:

Name of the Organization:

Address:

Products/ Services offered:

Suggestions for the growth of your Alma Mater:

ALUMNI COORDINATOR HOD PRINCIPAL

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