Alumni Registration

Dayawati Modi Academy Rampur (U.P.)

Alumni Registration Form
Fields marked with (*) are mandatory.
	First Name*	Middle Name		Last Name*
Student Name*
Father's Name*
Mother's Name*
Date of Birth*
Passout Year*		Last Class Attended*
Stream*		Highest Qualifiaction*
Marital Status*	MarriedSingle	Occupation*
Department		Designation
Address*		Country*
State*		City*
Phone No.	(Eg-: 01452465879)	Mobile No.*	+91
Email Id*		Memorable Moment

User Name*
Upload Image*
	Note: Student image file size must be less then 60 kb Acceptable Image Formats: jpg, jpeg