osa logo UPLIFMENT THROUGH EDUCATION SINCE 1974

OLD STUDENT'S ASSOCIATION

Of M. H. Saboo Siddik Institute Of Engineering & Technology

8, Saboo Siddik Polytechnic Road, Byculla, Mumbai - 400 008, India

Phones : 23084881 / 82, Email : osa659@yahoo.com.in - Website : osasiddikians.org

General Secretary Old Student's Association of M.H.S.S Institute of Engineering & Technology Mumbai - 400 008.

MEMBERSHIP FORM

Regd. No. BOM 158/77 G.B. B.S.D Regd. Public Trust No. f 4527

Date:

Form No:

Dear Sir.

I wish to become a Provisional Member of the 'OSA' . send herewith Rs. as fees. I hereby declare that I have read the aims and objects of the Asoociation and I fully subscribe to them.
Name in full:

(begining with surname)

Address:
Qualification:

Years in the Institution:

to

Course

Profession / Occupation:
Hobbies / Interests / Specialisation:

Tel Office:

Cell:

Residence:

E-Mail:

Signature:

(1) Patron - Rs.10,000/-
(2) Symphathiser Life Member Rs.5000
(3) Life Member - Rs.5000
(4) Provisional Member (Freshers) Rs. 1000/-for 3 years.
_______ For Office Use Only _______

Accepted / Rejected

Sl. No:
Membership No:
Receipt No span:
Date: