Alumni Association

Indian Institute of Technology Kanpur

Lifemembership Application Form

Lifemembership Application Form For Recent Graduates (2013 Onwards)

Please provide us with the following information to register in the IITK Alumni Directory. The fields marked with a red star (*) are mandatory.

Initial Information

First Name* 
Middle Name
Last Name
Gender 
Roll No.* 
Degree* 
Branch* 
Pass Year 
Convo Year* 
Any other degree from IIT Kanpur
Roll No. 
Degree 
Branch 
Convo Year 
Date of Birth (mm-dd-yyyy)*   
Father's name 
Thesis Supervisor 
IITK E-Mail* 
Primary E-mail* 
Alternate E-mail-1 
Alternate E-mail-2 
Alternate E-mail-3 
Alternate E-mail-4 

Residence Address

Flat/House/Block No Road/Street/Post Office
Town/City/District If any other please specify
State If any other please specify
Country If any other please specify
Postal Codee
Phone1 Phone2
Fax Mobile

Office Address

Company
Designation
Flat/House/Block No Road/Street/Post Office
Town/City/District If any other please specify
State If any other please specify
Country If any other please specify
Postal Code
Phone1 Phone2
Fax
Address for correspondence
Photo (Single Background Color Passport Size Photo)   
Copy of No Dues Form (Not Required to submit leave it)  

  Please bring your completed and signed photocopy of No Dues Form.

• I agree that the above data may be used to update the Alumni Association databse.
• I agree that the above data may be shared with IIT Kanpur and other alumni for special purposes.
• I agree to pay the Alumni Association, IIT Kanpur an amount of Rs. 2000.00 (Rupees Two thousand only) towards my Life Membership Fees dirctly from the Institute caution money which is deposited with IITK during my admission.