UDCT Alumni Association (UAA) http://www.udctalumni.org.in

c/o Institute of Chemical Technology (University under Section 3 of UGC Act of 1956;

Elite Status and Centre of Excellence- Govt of Maharashtra 2012)

Nathalal Parekh Marg, Matunga Mumbai-400019, India

Telefax: +91-22- Email:uaa@ictmumbai.edu.in

Homepage: www.ictmumbai.edu.in

MEMBERSHIP APPLICATION and SUPPORT PLEDGE

Date:

Dear ………………………….. It is our immense pleasure to invite you to join the UAA as a member and be part of a family to which you belong and were longing to connect. Our Alma Mater the old UDCT or MUICT has now been granted a status of a deemed University in recognition of its accomplishments and unparallel track record which would not have been possible without the contributions of so many individuals – students, faculty, support staff, alumni, well wishers, philanthropists, donors and industries. The State of Maharashtra accorded the Elite Status and Centre of Excellence on 20th April 2013 in the Assembly on par with the IITs,IISc Bangalore and IISERs as a tribute to its accomplishments. If you glance through the pages of history of technological advancement of modern India, the ICT stands out as the best example for others to emulate. We have been trying to reach all our graduates and associates, teachers and well wishers to join us in the process of institute building so that the ICT converts itself as a world class innovation university. We cannot do it without you. Please join this great family of UAA, tell us about your experiences and advise us as how to be in the forefront of knowledge creation and propagation. Remember all leading universities in the Western World are great because their alumni care for them, participate in their activities, advise them on every front and are their torch bearers. We need to create a brand of our own and it is here that you are needed. Try to reach out to your classmates and acquaintances from the ICT and create an occasion to visit the Alma Mater – let that be reunion of your class ; decennial, silver, golden or any other milestone you deem it fit to gather. Bring your family to the ICT and show how your destiny was changed by the portal of excellence. Not only you become a Life Member but also pledge annual support to the institute and mentor some of the young students and faculty, if you could afford to do. If you are in the city of Mumbai, please do visit and meet the Vice Chancellor and your teachers and friends. Our doors are always open- indeed there are no door literally . Join us today. With best regards, Yours sincerely,

Alumnus of ICT /Head of Department

President, UAA Vice Chancellor , ICT

Name in Full (beginning with last name or surname)

Stick your photo here

Address for correspondence

City State PIN-

Land line Email (personal)

Mobile number Homepage (if any)

Permanent Address

Landline

City State PIN-

Occupation , title and address of organization

Email (organization )

City State PIN-

Landline Homepage (if any)

Cell number

Degree(s) earned from ICT

B.Chem.Eng./ B.Sc.(Tech.)/B.Tech./ B.Pharm. .

M.Chem.Eng./M.Sc. (Tech.)./M. Pharm / M.Sc.

Ph.D.(Tech.)/Ph.D.(Sc.)/Occasional Research Student/Visiting Student/Well Wisher/Visiting Faculty

Year of graduation/Period of Association with ICT

Branch

Names of my classmates or contemporaries who could be contacted by UAA .

Name City of residence Mobile number and/or email (one of the two)

I would like to be a Co-ordinator for my Class and be in touch

with them for future

programmes and get-

togethers.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Or Group i.d. We are in touch through group i.d. and will allow UAA to be added to the list.

Group i.d.

For Current Students I am currently enrolled for the following course. I would like to be a well wisher member now which can be converted into the Life Membership on successful completion of my programme. I authorize the ICT to convert my security deposit into life membership.

Current enrolment B.Chem.Eng./B.Tech./B.Pharm. .

M.Chem.Eng./M.Tech./M. Pharm /M.Sc.

Ph.D.(Tech.)/Ph.D.(Sc.)/Occasional Research Student/ Visiting Student/ Visiting Faculty /Visiting Fellow

Year of admission/Period of Association as Visitor

Date: Signature :

Office use only

Payment received by Cash/DD/Cheque/Credit

Card

Cheque/DD number and Date

Name of Bank and Branch

Credit card (online) VISA/MASTERS/Any

Other Valid Card

Date of Expiry

Name of the Bank and number

Received in UAA office : Date and

receipt number.

Fee: Rs. 2000 life membership+Rs.100/- entrance fee ; US$200 for foreign members.