MSMI Membership Form

Note: Please submit the membership form below and mail the Membership Fee to the address given below.

Membership Fee :	· Individual :    $20/year · Family :    $30/year · Life Membership : $250
Donors:	. Grand Patron : $150 Ganapati and Diwali free for family of 4 . Donor : $100 Tax exempt receipt will be provided
Make checks payable to :	Maharashtra Sneha Mandal of Indiana (MSMI)
Please mail your checks to :	Treasurer MSMI 10875 Fairwoods Drive Fishers, IN 46037-8804

First Name		MI		Last Name
Address1
Address2
City		State	Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip
Telephone #	xxx-xxx-xxxx
Email Address	You can add multiple e-mail addresses separating each e-mail address with a semi-colon (;)
Spouse's Name
Children's Information
Child 1 Name			Year Born
Child 2 Name			Year Born
Child 3 Name			Year Born