MEMBERSHIP FORM

DATE: ________________ RENEWAL :________ NEW MEMBER:_______

NAME: MR/MRS/MS: _________________________________________________________

ADDRESS: _________________________________________________________

STATE:_______________ ZIP CODE: _____________

HOME PHONE NUMBER (WITH AREA CODE): ___________________________________

OFFICE PHONE NUMBER (WITH AREA CODE): ________________________________

E-MAIL ADDRESS: ____________________________________________________________

TYPE OF MEMBERSHIP: Please check one.

PATRON ($250)	.	FAMILY ANNUAL MEMBER ($30)	.
FAMILY LIFE MEMBER ($200)	.	ANNUAL MEMBER ($20)	.
LIFE MEMBER ($100)	.	STUDENT MEMBER ($10)	.

Family Members (Life or Annual) - Please specify the names of your family members.

______________________________________________________________________________

HOBBIES AND INTERESTS: Please check all that apply.

DRAMA	.	DANCE - BHARATHANATYAM	.
SPORTS	.	DANCE - KATHAK	.
LITE MUSIC	.	DANCE - OTHER	.
CLASSICAL MUSIC	.	OTHER	.

Would you like to perform volunteer work during Koota’s functions? Please check all that apply.

POOJA ARRANGEMENTS.	.	DATABASE MANAGEMENT	.
STAGE ARRANGEMENTS	.	PHOTOGRAPHY	.
FOOD PREPARATION	.	VIDEO	.
FOOD DISTRIBUTION	.	SOUND SYSTEM	.
LIBRARY MANAGEMENT	.	MEMBERSHIP DRIVE	.
FRONT DESK	.	CULTURAL ACTIVITIES	.

NOTE: Please renew your membership by end of SEPTEMBER. Your contribution is Tax deductible. Please make check payable to KANNADA KOOTA OF NEW YORK, INC.