Membership Form: Life Member/ Donor Member

Membership Form: Life Member/ Donor Member

All the ex-darrangians are hereby requested to fill-up the following particulars.....
Upload your recent passport size photograh
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Name*

First NameMiddle NameLast Name
Batch (Period in the College)*
Stream*
Subject
Occupation*
Present Activity
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Mobile/Phone Number*

Area CodePhone Number
Memorable activities in the College days
Any achievement in your life
Registration Fee:

(Life Membership/Donor Member Certificate will be provided)

[kindly send reference number or cheque number with date]
Kindly Click the Membership Option:

Life Member Rs. 5,000 onlySilver Donor Member Rs. 25,000 & above.Gold Donor Member Rs. 50,000 & above.Jewel Donor Member Rs. 1,00,000 & above.
Deposit the amount of Registration in the SB Account of UCO Bank, Tezpur:

Name of the Account: Darrang College Alumni Association

Account No. : 02440100007321

IFSC: UCBA0000244

Help Desk No.: +91 96134 18906
Bank Transaction/ Reference No. or Cheque No. with Date
Should be Empty: