Gujarati Association of Western Mass
106 Capital Drive,
West Springfield, MA 01089
2015 MEMBERSHIP FORM
Primary Member: ________________________________
(Last name, First name, Middle Initial.)
Spouse Name: _______________________________
Membership Fee of $250 per Family, per year.
Includes Member, spouse, unmarried children and 2 elderly parents ALL LIVING AT
THE SAME ADDRESS.
Please add extra $100 per person staying at the same address
Additional married family members require a separate membership.
Un-Married Children:
Name
Gender
Birth date
2 Elderly Parents living at the same address
Name
Relationship
Age
Extra Person Living at the same address (Please include $100 per person in the check)
FamilyMembership
Extra Persons/Service
Total Amount
250
Member Mailing Address: ________________________________________________
Telephone: Home:_________________ Cell:__________________
Fax: _________________ Email:___________________
Please make checks payable to:
Gujarati Association of Western Mass
Mail to: Shane Patel, 106 Capital Drive, West Springfield, MA 01089
More Questions? Please call Meena Gada, GN Patel, or Shane Patel or e-mail:
gawm12@gmail.com.
Please visit www.gawmonline.org