To The Secretary, Alumni Association, IIT Kanpur I request you to kindly admit me as a LIFE MEMBER of the Alumni Association and issue the membership card. The fields marked with a star (*) are mandatory. Initial Information First Name* Middle Name Last Name Roll No.* Permanent Email* Alternate Email Major* ----Select Degree----VLFMBSBS-MS(DUAL)BTMSC2MSC5PHDMTDIITMEMMPHILMBAMDESMT(DUAL)MT-PHD(DUAL)MSC-PHD(DUAL)BS-B.Tech/ECO-CSEBS-B.Tech/MTH-CSEMS (By Research)/MEMS (By Research)/EEOther Minor ----Select Degree----VLFMBSBS-MS(DUAL)BTMSC2MSC5PHDMTDIITMEMMPHILMBAMDESMT(DUAL)MT-PHD(DUAL)MSC-PHD(DUAL)BS-B.Tech/ECO-CSEBS-B.Tech/MTH-CSEMS (By Research)/MEMS (By Research)/EE Other Branch* ----Select Branch----AEBSBECECHECHMCSEECOEEEEMENVHSSIMELTLTPMATSCMDESMEMMEMSEMSPMTHNETPHYSTAT Passing Year* ----Select Passing Year----19641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Convocation Year* ----Select Convocation Year----196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020 Address Gender Male Female Social Media Links: LinkedIn Facebook Twitter YouTube Future Plans: Corporate Higher Studies Preparing for Govt. Exams Entrepreneurship Any Other Area Company Designation College Degree Exam Date of Examination Venture Area Photo upload / Link of the photo: File* Accepted file types: jpg, png, jpeg. *Max Upload Size is 2 MB Photo Link Any Post Held At IIT Kanpur Would you like to receive future communications from your alma mater: Yes No * I agree that the above data may be used to update the Alumni Association database. I agree that the above data may be shared with IIT Kanpur. I agree to pay the Alumni Association, IIT Kanpur an amount of Rs. 2000/- (Rupees two thousand only) towards my Life Membership Fees directly from the Institute caution money which I had deposited with IITK during my admission. This money can also be used in building the corpus of the Alumni Association. Date This iframe contains the logic required to handle Ajax powered Gravity Forms.