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Platinum Jubilee
  MEMBERSHIP FORM  
       
  Maiden Name :  
  Address :  
  Present Name & Address :  
  Date of Birth :
(fill like :01/12/2007) 		 
  Contact : (mob)
  
  Phone (Res.):  
  Fax No. :  
  E-mail Address :  
  Academic Qualification :  
  Occupation / Profession :  
  Year of leaving L.A.D. College :  
  & Class :  
  Faculty :  
  Medium :  
  Areas of special interest :  
  Membership of Social Organisation / Clubs if any :  
       
  Areas where you would like to contribute in development of the College :  
 
 
   
Kindly contribute Rs. 100/- for this organisation, if working.  
Ex-students not-working Rs. 30/-.  
Settled abroad $ 20