Life Membership Form

Life Membership Application Form For Graduating Students

Guidelines

Kindly share the soft copy of no dues form at alumni_office@iitk.ac.in
Permanent address should be your complete address where hard copy of alumni card to be post.
Photograph requirements:

The face of the candidate should be straight and at the centre.
Photo, wearing caps and dark glasses, informal will be rejected.
Image file should be in jpg format (Jpeg).
Image file should be less than 2 MB.

Personal Information

First name*

Middle name

Last name

Roll No.*

Email address (Except IITK Email)*

Permanent Address* (With Pincode)

Degree (Discipline/Branch)*

Passing Year*

Convocation Year*

Gender*

Mobile number*

Whats app Number*

DOB*

Social Media Links

Linkedin Link

Twitter Link

Please upload a Passport size photograph for Alumni ID-Card*

(Only jpg images)

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.