Alumni Association

Indian Institute of Technology Kanpur

Life Membership Application for Unregistered Alumni

Please fill in your details

Roll No.* 
First Name*
Middle Name 
Last Name 
Last Name After Marriage 
Gender
Email ID* 
Degree* 
Branch* 
Pass Year* 
Address* 
Contact Number* 
Present Employer
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Any Other degree from IIT Kanpur  
Yes, I want to pay Rs. 2500 as my Life Membership fee of the Alumni Association IIT Kanpur and issue me a Life Membership card

Total amount to be remitted in
INR 
OR
USD 
Date of Remittance (mm-dd-yyyy)*    
Amount remitted by