LIFE MEMBERSHIP FORM

St. Xavier's College Calcutta Alumni Association

Basic Information

Academic Details

Other Details

Documents

Step 1 of 4: Basic Information

Please fill in all required fields marked with *

Validation Tips

All errors will be highlighted in red and explained

I. Personal Details

First Name

Please enter your first name

Middle Name

Last Name

Please enter your last name

Father's/Mother's Name

Please enter parent's name

Gender

Male

Female

Other

Please select your gender

Marital Status

Single

Married

Please select marital status

Blood Group

Date of Birth

Please enter your date of birth

II. Contact Details

Email Address

Please enter a valid email address

Mobile Number

+91

Please enter a valid 10-digit mobile number

Landline

Present Occupation

Please select your occupation

Other Occupation (if not listed)

Designation

Please enter your designation

III. Permanent Address

Address Line 1

Please enter address line 1

Address Line 2

City

Please enter city

State

Please enter state

ZIP Code

Please enter ZIP code

Country

Please select country

Present address is same as permanent address

IV. Present Address

Address Line 1

Please enter address line 1

Address Line 2

City

Please enter city

State

Please enter state

ZIP Code

Please enter ZIP code

Country

Please select country

V. Office Address

Company Name

Please enter company name

Communication Address

Permanent

Present

Office

Please select communication address

Office Address Line 1

Please enter office address

Office Address Line 2

City

Please enter city

State

Please enter state

ZIP Code

Please enter ZIP code

Country

Please select country

Office Phone

Please enter office phone

Office Landline

VI. College Years

Course 1

Please select course

Roll Number

From Year

Please enter from year

To Year

Please check the year gap

Additional Course (Optional)

Course 2

Roll Number

From Year

To Year

Please check the year gap

VII. Qualifications Earned After College

Degree/Diploma	Institution	Year	Action

VIII. Membership in Other Organizations

Name of organization and nature of membership

IX. Awards/Honors/Membership Earned

Awards/Honors/Membership earned

X. Family Details

Spouse Name

Date of Anniversary

XI. Special Interest Areas

Special Interest Area

Please Specify

XII. Reference

Referring Member Name

Referring Membership ID

XIII. Upload Documents

Note: Please ensure all documents meet the specified requirements before uploading.

Photograph

Upload Photograph

Passport size - 200px × 200px JPG image only, 2 MB file limit

Please upload a photograph

Signature

Upload Signature

JPG/PNG format, 2 MB file limit

Please upload a signature

Graduation Certificate/Marksheet

Upload Certificate/Marksheet

JPG or PDF only, 2 MB file limit

Please upload graduation certificate/marksheet

I accept to receive SMS / WhatsApp from SXCCAA regarding membership, events & activities updates

Please accept to receive SMS

I hereby declare that the information provided is true and correct to the best of my knowledge

Please accept the declaration