Gujarati Samaj of Detroit

After you have filled out the form please click on the "Generate Printable Version" button below, and your form will then be re-generated on your screen, so you may print it out and mail it with a check

I hereby submit my application to become member(s) of Gujarati Samaj of Detroit for the year 2001:

Please Choose Membership Type:
Are you a first time Member? (Initial Fee of $10 in addition to annual dues)
First Name:
Middle Initial:
Last Name:
Age:	(if applying for student membership)
Address:
City:
State:
Zip Code:
Telephone:
E-Mail Address:
Family Information:
Spouse:

Children:	Sex:	Grade:	Age:




* Family is defined as a unit consisting of husband, wife, and their unmarried children under the age of 21
Would you like to have your name & address published in the directory:**
Would you like to have your phone number published in the directory:**
** Please answer YES or NO, if you did not answer, both will be printed as listed.

Gujarati Samaj, Inc.
1706 Melville Dr.
Rochester Hills, MI 48307