Registration - Golden Jubilee Celebration

Those who are not using this google form, please fill in this registration form and send with proof of payment to

KUPAAH UCPSc C/o. Leads Pharma Pvt. Ltd.,BPS House

# 4-3-775, Hanuman Vyayamshala Swimming Pool Lane, Sultan Bazar, Hyderabad – 500095

(or)

Email: regkupaahucpsc@gmail.com, WhatsApp: 9849702431

Kakatiya University Alumni Registration (Static)

PERSONAL PROFILE

1. Name (in full):

2. Gender:

3. Date of Birth:

4. Marital Status:

5. Spouse Name:

6. Number of Children:

7. Residential Address:

8. Personal Mobile Number:

9. E-mail ID:

ACADEMIC PROFILE

1. B.Pharm (University/Year of Completion):

2. M.Pharm (University/Year of Completion):

3. Ph.D. (University/Year of Completion):

4. Additional Qualifications (if any):

JOB PROFILE

1. Present Company/Institution Name:

2. Designation:

3. Company/Institution Address:

4. Mobile Number:

5. E-mail Address:

6. Member in any other Organizations:

7. Outstanding Achievements:

Sl.No	Details of Delegate Fee	Amount Per Person
1	Delegate fee for Alumni	Rs. 3000
2	Delegate fee for accompanying Spouse	Rs. 1500
3	Delegate fee for UCPSRc Research Scholars	Rs. 1000
4	Delegate fee for UCPSRc Students	Rs. 500

Payment

UPI ID: 9849164095@sbi

Date: ___________

Signature: ___________

kupaah golden jubilee

KAKATIYA UNIVERSITY PHARMA ALUMNI (1974-2025)

Those who are not using this google form, please fill in this registration form and send with proof of payment to

Golden Jubilee Celebrations of
KAKATIYA UNIVERSITY PHARMA ALUMNI (1974–2025)

REGISTRATION FORM

OFFICE USE

kupaah golden jubilee

Important Links

Events

Address

Those who are not using this google form, please fill in this registration form and send with proof of payment to

Golden Jubilee Celebrations of KAKATIYA UNIVERSITY PHARMA ALUMNI (1974–2025)

REGISTRATION FORM

OFFICE USE

kupaah golden jubilee

Important Links

Events

Address

Golden Jubilee Celebrations of
KAKATIYA UNIVERSITY PHARMA ALUMNI (1974–2025)