MEMBERSHIP FORM
FOR
MAHARASHTRA MANDAL OF KANSAS CITY

Date of membership                          ______________________

Name                                                 ________________________     ________________________     _____
                                                         (Last name)                              (First name)                             (Middle Initial)

Address                                             _________________________________________________

                                                          _________________________________________________

                                                          _________________________________________________

Telephone number(s)                         _________________________________________________

Email address (if any)                        _________________________________________________ (if you wish to get emails from the mandal)

Member additional information

Additional member name                             Relationship with primary member

1. ________________________________             ___________________________

2. ________________________________             ___________________________

3. ________________________________             ___________________________

4. ________________________________             ___________________________

5. ________________________________             ___________________________

Any hidden talents to specify

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