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COLUMBIA UNIVERSITY ALUMNI ASSOCIATION OF INDIA

MEMBERSHIP APPLICATION

PLEASE TYPE OR PRINT YOUR ANSWERS:

NAME: ____________________________________________________________________

COLUMBIA SCHOOL:A)_______________ DEGREE:___________YEAR:___________

B)_______________ ___________ ___________

HOME ADDRESS:___________________________________________________________

___________________________________________________________

___________________________________________________________

HOME PHONE (S): _________________________ __________________________

EMAIL: _________________________

BUSINESS:
COMPANY NAME: _________________________________________________________

YOUR TITLE: _________________________________________________________

ADDRESS: _________________________________________________________

_________________________________________________________

_________________________________________________________

EMAIL: _________________________

BUSINESS PHONE: _________________________ BUSINESS FAX: ________________

PREFERRED
MAIL ADDRESS: HOME:_____________ OFFICE:____________ OTHER:___________

YOUR HOBBIES: ___________________________________________________________

___________________________________________________________

___________________________________________________________

___________________________________________________________
(Please Turn Over)

1001, Peninsula Tower, Peninsula Corporate Park, G. K. Marg, Lower Parel, Mumbai - 400 013.
Tel : 91-22-5650 3900 Fax : 91-22-56503939
MY SUGGESTIONS FOR COLUMBIA CLUB OBJECTIVES ARE:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

SUGGESTED COLUMBIA CLUB PROGRAMS:

___________________________________________________________________________

___________________________________________________________________________

I WILL BE INTERESTED TO HELP: YES MAYBE NO


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PLEASE USE MY CHEQUE FOR THE REASONS LISTED BELOW:

A. NOT TAX EXEMPT

ENROLMENT: RS.1000 _____________

DUES: YEAR 2008 RS.500 _____________


YEAR 2009 RS.500 or see _____________
YEAR 2010 RS.500 below _____________
YEAR 2011 RS.500 _____________
YEAR 2012 RS.500 _____________

NUMBER: __________________________ PAN : _________________________


B. TAX EXEMPT ACCORDING TO COUNSEL

LIFE TIME DONATIONS (ANNUAL DUES NOT NEEDED) RS. 7,500

DONATION TO CORPUS FUNDS FOR THE CLUB


TOWARDS SCHOLARSHIP FUND FOR INDIAN
STUDENTS GOING TO COLUMBIA FOR GRADUATE STUDIES ____________

TOTAL MONEY ENCLOSED ____________

MAKE CHEQUES PAYABLE TO: THE COLUMBIA UNIVERSITY ALUMNI


ASSOCIATION OF INDIA
PLEASE MAIL THIS FORM TO : COLUMBIA CLUB
1001, PENINSULA TOWER,
PENINSULA CORPORATE PARK, G. K. MARG,
LOWER PAREL, MUMBAI : 400 013.

1001, Peninsula Tower, Peninsula Corporate Park, G. K. Marg, Lower Parel, Mumbai - 400 013.
Tel : 91-22-5650 3900 Fax : 91-22-56503939

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