Membership Application

To initiate your membership application, please fill out and submit the online form below. Membership fees may be sent by cheque, or by wire transfer both from within India and overseas. You will get payment details as soon as you submit the form below.

Salutation * Select Mr Ms Dr Name * Address (Line 1) * Address (Line 2) City * State Country * Select Albania Argentina Armenia Australia Austria Bangladesh Belarus Belgium Bolivia Bosnia Brazil Bulgaria Cambodia Canada Chile China Colombia Costa Rica Croatia Cuba Cyprus Czech Rep. Denmark Ecuador Egypt El Salvador Estonia Ethiopia Finland France Germany Greece Guatemala Haiti Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Kuwait Latvia Lebanon Liechtenstein Lithuania Luxembourg Macedonia Malaysia Malta Mexico Monaco Morocco Myanmar Nepal Netherlands New Zealand Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Romania Russia Saudi Arabia Singapore Slovakia Slovenia Somalia South Africa South Korea Spain Sri Lanka Surinam Sweden Switzerland Syria Taiwan Thailand Turkey U.A.E Ukraine United Kingdom Uruguay USA Uzbekistan Venezuela Vietnam Yemen Zambia Zimbabwe Postal Code * Home Phone Mobile Phone

* Mandatory Fields E-Mail * Alternate E-Mail Alumni/Faculty at * Select IIT Bombay IIT Delhi IIT Guwahati IIT Kanpur IIT Kharagpur IIT Madras IIT Roorkee Year of Graduation * Select Faculty Member1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Degree * Department * Work-related information Industry * Organisation Name * Function * Position * Office Phone

Please choose the membership type: *
	Patron
	Principal Member
	Donor Member
	Resident Alumnus
	Resident Faculty (Current)
	Resident Faculty (Retired)

Would you like to do any voluntary work for the Club? If so, please give details
Any other details you may wish to add

	I have read and understood the Bye-Laws and Rules of the IIT Alumni Club and I hereby undertake to abide by them, as amended, from time to time.