Registration

Institution

Course *

Year of Passing *

Enrollment Number

Personal Information

Name of Alumnus during admission to course *

Gender *

Male Female Other

Name of Father *

Mr.

Name of Mother *

Mrs.

Date of Birth *

Mobile Number *

Email Id *

Address

Permanent Residential Address

City / Pin Code

Country / State

Same as Current Residential Address

Present / Postal Residential Address *

City */ Pin Code *

Country */ State *

Occupation

Name of Organization *

Working Designation / Position *

City / Pin Code

Identity

Password * (Your primary mobile number is your login-id)

Confirm Password *

Passport Size Photo (JPG / JPEG / PNG)

(Minimum resolution required for best image quality : 100px 100px)

I Agree

I hereby declare that the information provided by me is true and correct to the best of my knowledge. I authorize Prestige Institute of Management & Research, Dewas to use this information for alumni records and institutional communication.

I Agree You must select this box to proceed.

Alumni Registration Form - PIMR Dewas