Membership Form
FOR REGISTERING AS MEMBER OF SGPGIMS ALUMNI ASSOCIATION.
Membership is Open To all Past Students (Including Non Academic Regular Senior and Junior Residents ) and Past & Present Permanent Faculty enrolled at SGPGIMS Lucknow.

LIFE TIME MEMBERSHIP FEES Rs 5000 (FIVE THOUSAND ONLY)
 
Account Details : SGPGIMS ALUMNI ASSOCIATION
                               Current Account  41760508070
                               State Bank of India , SGPGIMS Branch , Lucknow
                               IFSC Code SBIN0007789

Cheque and Draft to be made in the name of "SGPGIMS ALUMNI ASSOCIATION" payable at Lucknow 

Alumni Office 
Room No. 9, Ground Floor, Dep’t of Endocrinology, C-Block SGPGIMS,  Raibareili Road , Lucknow 226014(U.P.) India .  Email : sec.sgpgialumni@gmail.com
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Email *
SCAN THE QR CODE BELOW FOR ONLINE PAYMENT THROUGH UPI AND SAVE  THE TRANSACTION ID 
ASSOCIATION LOGO
Are you a *
Required
Name *
Name As per SGPGIMS Records . Do not add prefix like Dr/Prof etc.
Gender 
Present Designation *
Department/s Attended at SGPGIMS *
Select the  Department/s You were enrolled  / or have Been Permanent Faculty  at SGPGIMS 
Required
Course Type Attended at SGPGIMS
 *
Required
Name of Course and Department 
 *
Name of Course and Department (e.g DM Cardiology/M.Ch Urology/PDAF  Cardio-vascular and Thoracic Anaesthesia/ PDF Paediatric Onco Surgery/ MD Pathology/ MHA Hospital Administration etc)  . If only Permanent Faculty - write Name of Department 
Date of Birth  *
MM
/
DD
/
YYYY
Year of Joining SGPGIMS  *
Year (In four Digits) when you joined SGPGIMS  (e.g 1996; 2003 etc) 
Year of Leaving / Completion of Course  *
Year  (In four digits) when you completed or left the course (e.g 1999, 2006 etc). If Registering as Faculty at SGPGIMS write " 2024 "
Email *
Corresponding Address with Pin Code  *
Present City of Work *
Mobile Phone number *
Please add Country code before number (e.g  for India 91XXXXXXXXXX)
Land Line Number 
Enter Country  & City code before the Number  ( e.g. For Land line in Lucknow  91522xxxxxxx) Dont Leave spaces between numbers 
Present Working Affiliation  *
Working Designation  and Address 
Mode of Payment  *
Account Details : SGPGIMS ALUMNI ASSOCIATION
                               Current Account  41760508070
                               State Bank of India , SGPGIMS Branch , Lucknow
                               IFSC Code SBIN0007789

Cash payments are not accepted with this form. For Cash payments visit the society office to fill offline form.
QR CODE FOR UPI PAYMENT
QR CODE FOR UPI PAYMENT
Date of Payment *
Mention the Date of Online transaction or cheque/Draft Issue date
MM
/
DD
/
YYYY
Transaction ID/Cheque/Draft Number  *
Enter the UPI/NEFT UTR/Cheque or Draft Number.
Membership confirmation will be done after realisation of payment in the Bank Account and the Credentials are verified by your Parent Department.
How Would You Like to Help the Association in its Future Endeavors and your Expectations from it.
Please add sec.sgpgialumni@gmail.com  and ankurbhatnagar2000@sgpgimsalumni.com to your contact list to prevent communication going into your spam folder.
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