Hanagal Shri kumareshwar College of Pharmacy

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Alumni Association H.S.K.College of Pharmacy, Bagalkot

Name [in Capital]*	DOB [DD/MM/YYYY]:

Sex	Qualification*
MaleFemale
Year of Graduation: *	Present position:

Organization

Residential Address	E-mail:*

Phone (with STD code):	Cell:*

Are you a member of Alumni association:	Accommodation
YesNo	RequiredNotRequired
No. of occupants
Male	Female

Children

Accommodation details
Aradhana/Anugraha (Please follow the below Table)	Dhanalaxmi

Accommodation details:

Lodge	Single room	Double room	Double deluxe	A.C
Aradhana/Anugraha	----------	Rs 450+4% tax	Rs 575+4% tax	Rs 840+4% tax
Dhanalaxmi	Rs 230	Rs 320	Rs 480	Rs 800

Note:

1) Please pass on the information to your classmates/friends irrespective of your participation
2) For accommodation please send the DD in favor of Alumin association H SK College of Pharmacy payable at Bagalkot OR Online banking: Name of Bank account holder: Alumni Association H S K College of Pharmacy.
Bank: Corporation Bank; Account Number: 03170010104; Branch: Bagalkot; IFScode: Corp0000317
3) Address for correspondence Alumni Association H.S.K.College of Pharmacy, Bagalkot-587101, Phone: 08354-220008, Email: hskcop.bgk@gmail.com
4) For registration contact Dr.Laxman Vijapur Cell: 8105898479
5) For accommodation contact Dr.V.M.Chandrashekar Cell: 9880298342
6) Last date for registration 25/2/2014

Free Registration

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