Date………….…..

1. ACTRECALUMNI ASSOCIATION (Regd. No. MAHA/ 1358/ 11/ THANE) TATA MEMORIAL CENTRE Advanced Centre for Treatment, Research and Education in Cancer Sector 22, Kharghar, Navi Mumbai – 410210 Tel: 022-27405030 Fax: 022-27405085 Email: alumni@actrec.gov.in Website: http://www.actrec.gov.in/Alumni/index-2010.html • Appeal • For any Centre, the true worth of its activities lies in the success of its alumni in the long run. The “ACTREC ALUMNI ASSOCIATION” (AAA) - encompassing the erstwhile Indian Cancer Research Centre, Cancer Research Institute and Advanced Centre for Treatment, Research and Education in Cancer, was set up in 2006 to help strengthen the Centre’s links with its alumni. • AAA offers valuable programs to foster connections amongst all its alumni, while providing special benefits to members. The aims and objectives of the Association are: • To provide a forum for interaction between members of the Association and to sustain a sense of belonging amongst the members of the Association with the Centre through mutually beneficial contacts. • To provide avenues for drawing upon the knowledge and expertise of the alumni to further the social cause of the Centre as a leading Centre of Excellence. • To foster continuing professional/ academic development by drawing support from achievers amongst its members and the public in their respective fields. • To organize annual reunions, felicitation of eminent alumni as well as national and international conferences, seminars, workshops, symposia in selected topics of Science & Technology to strengthen/ share the knowledge base. • To award scholarships/ fellowships on such terms and conditions as the Executive Committee may deem fit, for the purpose of undertaking, pursuing and encouraging higher education and research. • On behalf of the Executive Committee, we invite you to be a “Well Wisher” of AAA by providing AAA valuable, monetary support. Please fill in the requisite details in the “Well Wisher Application Form” and send it to the Secretary along with your payment. • With best regards, • Dr Nishigandha Naik Dr Jyoti Kode • President Secretary Date………….….. Dr. Nishigandha Naik President Dr. Ulhas Ganu Vice-President Dr. Jyoti Kode Secretary Dr. Vivek Tanavde Joint Secretary Dr. Rajiv Gude Treasurer Dr. Tanuja Teni Joint Treasurer Members: Dr. Girish Maru Dr. Kalpana Joshi Dr. Laxmi Rao Dr. Neelam Shirsat Dr. Aparna Bagwe Dr. Veena Verma

2. Well Wisher No. ________ Office use only ACTRECALUMNI ASSOCIATION (Regd. No. MAHA/ 1358/ 11/ THANE) TATA MEMORIAL CENTRE Advanced Centre for Treatment, Research and Education in Cancer Sector 22, Kharghar, Navi Mumbai – 410210 Tel: 022-27405030 Fax: 022-27405085 Email: alumni@actrec.gov.in Website: http://www.actrec.gov.in/Alumni/index-2010.html Well Wisher Application Form To The Secretary ACTREC Alumni Association I/ We wish to support AAA activities by contributing** Rs. ____________________ (in words - Rupees _________________________________________________). Please enroll me as a Well Wisher of ACTREC Alumni Association (AAA). Payment details: Amount paid in Cash/ by Cheque no. __________ dtd _________ drawn on ______________________ Bank, ________________ Branch, in favour of “ACTREC Alumni Association”. If AAA Alumni/ Affiliate/ Associate Member Yes/No If yes, then Membership No. 1. Name: _____ _________________________________ __________________ Title First Name Middle Name Last Name 2. Company Name: _________________________________________________ 3. Address for Correspondence: (incl. Postal Code) 3. Phones: ____________________ / ____________________ / ___________________ Work Home Mobile 4. Fax: ____________________ 5. Email: ___________________________________ I/ We would like this amount to be utilized for General Purpose/ Specific Activity/ Award: Please specify: _________________________________________________ Date: Signature: ------------------------------------------------------------------------------------------------------------------------ Names of the following Well Wishers would be displayed on AAA Website: **Individual Sponsor: Rs. 5000/- and above Institutional/ Corporate Sponsor: Rs. 25,000/- and above Sponsor of a Specific Activity or Award: Rs. 1,00,000/- and above