Membership Form for Bala Vihar Alumni All the fields are mandatory. Personal details Salutation Mr. Mrs. Miss Master Smt. Shree Kum. Dr. Ms. Brni. Br. Sw. Swni. First Name Last Name Gender Male   Female Date of Birth JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 19421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994 Phone No.  -  -  Mobile No.  -  Email Id. Address City Pincode Country Photo Upload  Remove  View Show information to other Chinmaya Members Yes  No   Educational and Professional Summary Graduate year of passing Select MBBS BPT BE BDS BSc Bcom BA Pharmacy Ayurvedic Bed Ded Diploma Not Applicable   Select 19571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Post graduate year of passing Select MD MS ME MDS Med MSc MCom MA Not Applicable   Select 19571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Speciality Select Anatomy Physiology Biochemistry Pharmacology Pathology Microbiology Forensic Medicine Community Medicine Preventive & Social Medicine General Medicine General Surgery OBGYN Pediatrics Skin & VD Radiology Anaesthesiology Ophthalmology ENT Orthopedics Engineer Officer Constructor Networking/Hardware Programmer Not Applicable Other Present Status Select Practitioner Consultant Faculty Health Services Research Scholar Not Applicable Other Your Achievements   Bala Vihar Details Attended Bala Vihar From 19421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 To 19421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Your Bala Vihar is located at Select CountryAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHongKongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNiagaraRegionNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaYemenZambiaZimbabweother Other    Select Stateother Other   Select Cityother Other   Select An Areaother Other   Bala Vihar Address Pincode Sevak/Sevika's Name   Do you subscribe to Balvihar Yes   No Subscription Number field will be active only if yes. (The International Children's Monthly Magazine)? If yes, Enter your Subscription Number. If not, Would you like to subscribe to Balvihar? (Subscribers will receive Balvihar at their doorstep by post. They can also view the magazine online.) Yes   No   Bala Vihar Alumni Identity Alumni Login Id. *Maximum 10 characters  Password *Maximum 8 characters Confirm Password