DURGA TEMPLE
(A Tax-Exempt Organization)
8400 Durga Place, Fairfax Station, VA 22039
Phone: (703) 690-9355; website: http://www.durgatemple.org
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Membership Form – Durga Temple
LIFE MEMBERS: A person who contributes a one-time sum of $ 501.00 shall become a Life
Member effective from the date of donation. Children under the ages of 21 years will be considered
Life Members for similar contribution. The Life Members shall have the life time General
Membership privileges.
GENERAL MEMBERS: A person who contributes a one-time sum of $ 101.00 and subsequent
annual renewals shall become a General Member of the Temple. The General Members must pay
their dues by January 31 of each year to be eligible to vote in the Temple’s general body meetings.
------------------------------------------------------------------------------------------------------------------------_____New Members
_____Renewal
_____Information Update Only
___________________________________________
_________________________________________
Last Name
Spouse’s Name (First & M.I.)
First
M.I.
1)____________________2)____________________3)____________________4)____________________
Children’s Names (First & M.I.)
_______________________________________________________________________________________
Address (number, Street, city, state & zip code)
(_________)______________________________
(_________)_______________________________
Contact Phone No.
Alternate Phone No.
________________________________________
__________________________________________
E-mail (1)
E-mail (2)
_____ Please contact me to volunteer for the temple. I can help in_______________________________________
(Please fill in activities, tasks etc. of your interest)
MEMBERSHIP INFORMATION
____ General Member $101 ____ Life member $501
_____ Contributing Member $51,000
I have enclosed a check (No._________ ) - Payable to: Durga Temple for $ ___________ for my
membership and an additional donation* of $ _________ for a total of $ ___________ The cashed
check will be your receipt. Please DO NOT remit by cash to become a member or renewal of your
membership.
Please note: The spouse and the children under the ages of 21 years of a member automatically
become members. Each general/annual and life membership donation represents one (1) vote for
the election of the members of the Executive Board.
Signature: ____________________________________________ Date: ___________________
Please complete this form & mail it with your check TODAY to DURGA TEMPLE at the address
shown above, Attn: Membership Committee.
Please donate generously and participate in the Temple activities. Thank You for your support.