Membership Form - Kathmandu University

Kathmandu University Alumni Association(KUAA)
Application for Membership
Photo
Membership No.:
Membership Type:
Lifetime
Individual
The Member Secretary
Kathmandu University Alumni Association
Dhulikhel, Kavre, Nepal
As a graduate of Kathmandu University, I am interested in KUAA’s different activities and submitting
this application for the Association's membership so that I can contribute/involve in that. I assure you
that I will abide by KUAA’s existing constitution, and their future amendments.
I have enclosed Rs. 1500.00 for my life membership or Rs. 500 for individual membership (validity for
3 years) herein along with two copies of my recent photo (PP size 1 Auto size 1).
My personal details are as follows:
1. Name:
2. Permanent Address:
3. Place of Birth:
4. Date of Birth:
5. Mailing Address:
6. Nationality:
7. Present Job:
Organization Position Address Joined on
P.O. Box:
Tel (Work):
Fax No:
Tel (Residence):
E-mail:
Web:

8. Academic Qualification:
Level Subject Institute Study Period
PhD
Graduate
Undergraduate
Certificate
9. Involvement in Other Associations:
Association Position From
Note: If you want to add further personal details, please use another sheet(s) of paper.
The membership fee should be deposited in Nepal Investment Bank Ltd, the account number is
8196740.
Date: .................................................
Applicant's signature
........................................