Kazi Nazrul Alumni Association

Kazi Nazrul University, Asansol - 713340

West Bengal, India

Registration No: S0015431 of 2020-2021

Website: http://knu.ac.in/alumni/

MEMBERSHIP REGISTRATION FORM

Name:
Subject Studied:
Course of Study (PG/Diploma/B.Tech/BSc/LLB/M.Phil. /Ph.D.):
Mode: Regular/ Distance: PAN/AADHAR:
Year of passing:
Address of Communication:
Residential:

Official:

Phone No (with STD/ ISD Code): Mobile No:

Email:
Membership Fees: 500/- Present Occupation:
The name of Organization:
Address:
Designation:
Special achievements & any other details:

Place: ………..………………....… Date: …………………. Signature: …………………………………...

Membership fee/ donation may be deposited by DD in the name of Kazi Nazrul University Alumni
Association

Receipt number: ………………... Date: ………..………. Signature of the receiver: ……….…………