http://oocities.com/tvslakshmialumni Application for Life Membership

( LOSA IS REGISTERED UNDER SOCIETIES ACT,77/2001 ) .The payments should be mad in favour of LOSA, DD payable at Madurai. Outstation cheques pl add Rs.100/-.

Please enclose two stamp size photos/ and if your spouse is alumnus of TVSL, enclose another form.

Name :

Surname:

Nickname:

Qualification:

Date of birth:

Marital status                               if married: did your spouse study in TVSL?

no. of children:

email:

Address:

Tel:;                                         fax:                                     cellular:

Organization:

Designation:

Payment:

cheque/cash/dd: dated

Bank:

ForLOSA,

Signature of the applicant:

Remarks: