Alumni Registration

Dayawati Modi Academy Rampur (U.P.)

Fields marked with (*) are mandatory.

First Name*

Middle Name

Last Name*

Student Name*

Father's Name*

Mother's Name*

Date of Birth*

Please enter a valid date.

Passout Year*

Last Class Attended*

Stream*

Highest Qualifiaction*

Marital Status*

Married

Single

Occupation*

Department

Designation

Address*

Country*

State*

City*

Phone No.

(Eg-: 01452465879)

Mobile No.*

+91

Email Id*

Memorable Moment

Please select a Image(.jpg,.jpeg) file.

User Name*	*
Upload Image*	*
	File Size Limit 60 Kb Note: Student image file size must be less then 60 kb Acceptable Image Formats: jpg, jpeg