Chhandayan NY Membership Form

1. Name (Mr/Mrs):                                                                                                                  

2. Address:                                                                                                                              

3. Phone (Home):                                             (Work):                                                           

4. Fax:                                                              5. Email:                                                          

6. Mobile/Pager:                                                                                                                      

7. Category of Membership:

              Student/Senior Citizen                          Individual                      Dual/Family

                           Supporting                                            Patron

 8. Mode of payment:                Cash                Check              Credit card (visa/master card)
 
 9. If paying by credit card, specify type of card                           Visa                 Master Card

            Account No:                                         Expiration date:                        

            Name on the account:                                                                                                  

10. If you want to help us in organizing our events please specify the area of your preference

Food:                                                   Hosting:                                                                       

Set up:                                                  Sound:                                                 

Transportation:                                     Publicity: