Only Indian debit and credit card are accepted.
LIFE MEMBERSHIP FORM
Basic Information
Academic Details
Other Details
Documents
First Name
*
Middle Name
Last Name
*
Father's/Mother's Name
*
Gender
*
Marital Status
*
Blood Group
Please select
Please select
Date Of Birth
*
Email
*
Mobile
*
Landline
Address 1
*
Address 2
City
*
State
*
Zip
*
Country
*
Please select
Address 1
*
Address 2
City
*
State
*
Zip
*
Country
*
Please select
Present Occupation
*
Please select
Please select
Occupation
Designation
*
Communication Address
*
Company
*
Address 1
*
Address 2
City
*
State
*
Zip
*
Country
*
Please select
Phone
*
Landline
Course 1
*
Please select
Please select
Roll No
From Year
*
To Year
*
Course 2
Please select
Please select
Roll No
From Year
To Year
Degree
Institution
Year
Degree/Diploma
Institution
Year
Name of the organization and nature of membership
Awards/Honors/Membership earned
Spouse Name
Date Of Anniversary
Special Interest
Please select
Please select
Please Specify
Referring Member Name
Referring Membership ID
Photograph
*
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Signature
*
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Graduation Certificate/Marksheet
*
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I accept to receive SMS from SXCCAA
*
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IMPORTANT NOTICE
Currently only Indian Debit card and Credit card are accepted.
Do not keep the session long for more than 20 minutes, beyond which registration will Session Out.
Keep the following documents ready -
Passport size photo: 200px x 200px, jpeg only with 2MB file limit.
College Graduation certificate/Mark sheet: jpeg/pdf only with 2MB file limit
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