Membership / Change of Family / Address Form

Add my name and family information in the SPCS database and next Directory

I want to join SPCS as a Life Member. Membership fee $250 enclosed.

PLEASE CHECK THE APPROPRIATE BOX

Now you can fillout form, pay and update information online. Please visit our new and improved website www.spcsusa.org

Email : spcsnec@gmail.com

FOR SPCS USE ONLY

Date Received : Check No. : Lifetime Member No. :

MY CONTACT INFORMATION (Please write in UPPER CASE)

Name :

Address in USA :

Home Phone Office Phone*

E-mail address : (Member)

MY FAMILY DATA

Member Signature (required) Date

E-mail address : (Spouse)

E-mail address : (Children)

User Name : Password :

CHILDREN

Last Name

Middle Name

Father’s Name

Birth Month & Year

Hometown in India

First Name

Member Spouse(Info before marriage)

Last NameFirst & Middle Names Birth Year Male / Female Married / Single

Make revisions, as noted, in the SPCS database and next Directory.My SPCS Life Member No. : LM _________

Please make the check payable to : SPCSMail the form and check to: Please mail this form along with your registration form.

Saurashtra Patel Cultural SamajConvention 2018