Birla Institute Of Technology & Science Alumni Association (BITSAA)

Hyderabad

MEMBERSHIP & WINTER BASH 2004 RESPONSE FORM

(Please print and mail your response to: Sanjay Khendry, (Secretary BITSAA – Hyderabad), Sierra Atlantic, Karthik House, Road no 14 Banjara Hills, Hyderabad – 500 082)

Name: ______________________________ Year of Passing: _____ Discipline: _________________

Address: _________________________________________________________________________

Phone: (R) _______________ (O)________________ (C) ____________Email:_________________

Life Members: r Please find enclosed my cheque for Rs. 1000 towards LIFE membership

r Yes, I would like to participate in WINTER BASH 2004 on Feb 8^th 2004

Number of Adults: _______ Number of Children: __________

Annual Members: r Please find enclosed my payment of Rs. 100 (A) towards ANNUAL
membership

r Yes, I would like to participate in WINTER BASH 2004 on Feb 8^th 2004

Number of Adults (B): _______ (x Rs. 50)

Number of Children <12 (C) : __________ (x Rs. 50)

r Please find enclosed my cheque (A+B+C) for Rs. ___________

Cheque Details:

Amount: __________ Cheque No: __________ Dated: _________ Bank & Branch:__________________