| Name: .................................................................................................................................................................... |
| Permanent Address: .............................................................................................................................................. |
| Mailing Address: .................................................................................................................................................... |
| Telephone No. (with codes): (Off) .................................(Res.) ..............................(Email) .................................. |
| Name in School Records: ....................................................................................................................................... |
| Year of Joining School: .......................................................................................................................................... |
| Year of Leaving: .................................................................................................................................................... |
| Type of Membership: Annual/Life ........................................................................................................................ |
| Membership fee paid vide Cash/Cheque/DD No. ............................................ Rs. .............................................. |
| Amount (in words): ............................................................................................................................................... |
| Present Occupation: .............................................................................................................................................. |
| Designation: .......................................................................................................................................................... |
| Office Address: ...................................................................................................................................................... |
| Other Activities and Interests: ............................................................................................................................. |
| ................................................................................................................................................................................ |
* (Cheques/DD to to payable to "Lady Irwin School Alumni Association")
**Membership fee for both ordinary (ex-students) and associate members (retired teachers):
Annual Rs. 200/- and Life Rs. 2000/- |
