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Alsoc Membership Form

This document is a membership application form for the Alumnorum Societas (St. Xavier's School Old Boys' Association). It requests personal details such as name, date of birth, education history at St. Xavier's School, as well as current contact and employment information. Membership options include Life Membership for Rs. 5,000, Senior Life Membership for those over 60 years of age at Rs. 2,500, Ordinary Membership at Rs. 500, and Annual Subscription at Rs. 500 or Student Membership at Rs. 500. Payment details are also provided.

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173 views

Alsoc Membership Form

This document is a membership application form for the Alumnorum Societas (St. Xavier's School Old Boys' Association). It requests personal details such as name, date of birth, education history at St. Xavier's School, as well as current contact and employment information. Membership options include Life Membership for Rs. 5,000, Senior Life Membership for those over 60 years of age at Rs. 2,500, Ordinary Membership at Rs. 500, and Annual Subscription at Rs. 500 or Student Membership at Rs. 500. Payment details are also provided.

Uploaded by

daviskanjamala
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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ALUMNORUM SOCIETAS
(St. Xaviers School Old Boys Association)
30, Mother Teresa Sarani (Park Street), Kolkata- 700 016
Telefax: +91 (33) 2287-5735
E-mail: [email protected]
Web Site: www.alsoc.org
Alsoc Membership Number
: ___________________________________________________________________
MEMBERSHIP
APPLICATION FORM
To be filled by the Office
Applicants Name

: ___________________________________________________________________
(SURNAME)
(MIDDLE NAME)
(FIRST NAME)

Title (Mr./Dr. etc)

: _____________________

School Regn. No. : _____________________

Date of Birth

: _____________________

Blood Group

Fathers Name

: ___________________________________________________________________

Wifes Name

: _____________________

Profession (Tick as appropriate)

: Business/ Service/ Professional __________________________________________

: _______________________

Wedding Date: _________________________

: Others (please specify) ________________________________________________


Permanent Address

: House No. ______________________

Flat No. _____________________

Building Name: ______________________________________________________


Street Name: ________________________________________________________
City: _______________________________ PIN: __________________________
Country: ____________________________________________________________
Phone No.: __________________________________________________________
Names of Children

E-Mail:
: Name

Sex

Date of Birth

_______________________________ _______________

_________________

_______________________________ _______________

_________________

Year of Joining St. Xaviers School : ___________________________________________________________________


Year of Leaving St. Xaviers School :____________________________________________________________________
School Leaving Exam and Year

:____________________________________________________________________

(In case you left School before the School leaving exam, fill the year and exam which your batch would have
completed to leave School)

Fathers & Teachers who taught you : ___________________________________________________________________


___________________________________________________________________
___________________________________________________________________
Present Address

: House No. ______________________

Flat No. _____________________

Building Name: ______________________________________________________


Street Name: ________________________________________________________
City: _______________________________ PIN: __________________________
Country: ____________________________________________________________
Phone No.: __________________________________________________________
E-Mail:
Mobile No.: _________________________________________________________
Name of Organization

: ____________________________________________________________________

Address

: ____________________________________________________________________
Phone No.: ______________________________ Fax No.: ____________________
E-mail: _____________________________________________________________

Achievements:
Academic/ Sports/ Others

: ____________________________________________________________________

Area of Professional expertise


(In one or two words)

: ____________________________________________________________________

Sports in which interested

: _____________________________________________________________________

Note:- Xerox of School Leaving Certificate must be enclosed


Life Membership

- Rs. 5,000/-

Senior Life Membership

- Rs. 2500/-

(60 years and above)


Ordinary Membership

- Rs.

500/-

Annual Subscription

- Rs.

500/-

Student Membership

- Rs.

500/-

Mode of Payment

- Cash/ Cheque

Cheque in favour of ALUMNORUM SOCIETAS

Details for Bank Transfer


India
: Syndicate Bank, Park Street Branch,
Kolkata-700016
Savings A/C No:95852010012330
IFSC No :SYNB0009585
Overseas : Syndicate Bank, Park Street Branch,
Kolkata-700016
Savings A/C No:95852010018330
Swift Code :SYNBINBB120
FCRA Registration No: 147120872

Signature:
Date:

For Office use only:


Form received by____________________________________ Cash/Cheque of Rs. __________________
Cheque No. ____________________________ Date__________________ Drawn on ______________
Receipt No. ____________________________ Date____________________

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