Your name
Father's name
Branch
Year of Passing
Date of Birth
Date of Marriage Anniversary
Faculty Member —Please choose an option—YesNo
Present Designation/Last Designation, if retired
Name of Organization
Office/Business Address
Your email
Mobile/Phone Number
STD
Residential Address
Type of Membership —Please choose an option—Life Membership (Rs 5000/-)Annual Membership (Rs 1000/-)
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Please Transfer Rs.5000.0 to the following Account :
THE BENARES ALUMNI ASSOCIATION OF IIT(BHU ), SAVINGS A/C NO. 031001008317, IFSC ICIC0000310 MICR 221229003 , ICICI BANK, SIGRA, VARANASI
