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110 016 APPLICATION FORM FOR STUDENT MEMBERSHIP v WRITE EVERY ENTRY NEATLY AND LEGIBLY v TYPE OR 1. Name of applicant (student) (in capital letters) : 2. Date of Birth : 3. Year/Semester of Study : 4. Branch of study / Course of Study : 5. Address of Institution : 6. Home address (Permanent Address) : 7. Details of Remittance (Amount, draft number, bank etc.) : Amount D.D. Number : : Date Bank & Branch :.

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