Mr/Ms/DrMrMsDr
Name
Your email
Your Mobile No
Phone No (With STD Code)
PUC (AT MCC) YesNo
Subject
YEAR OF STUDY (YYYY)
NON-RESIDENT / RESIDENT RESIDENTNON-RESIDENT
Hall
UG. DEGREE (AT MCC)YesNo
PG. DEGREE (AT MCC)YesNo
M.Phil. DEGREE (AT MCC)YesNo
Ph.D. DEGREE (AT MCC)YesNo
Residential Address
Office Address
I am glad to pay Annual Membership - Rs.300/-Life Membership -Rs.2500/-Donor Membership -Rs.10000/- and above (Please specify amount) Mode of Payment CashChequeDemand Draft Particulars of Payment Cheque/Demand Draft, drawn in favour of the Bursar, Madras Christian College, Tambaram, may kindly be sent to the Alumni & Public Relations Officer, Madras Christian College, Tambaram, Chennai 59, along with this Registration Form.