2009-2010 Membership Application for
Greater Portland Tamil Manram (GPTM)
Member Last Year?
If Member last year, enter Mem #
First Name
Last Name
Membership Type
(
Select Liftime, or # of adults and children (6-12 yrs)
)
Lifetime - $750
No Adults
1 Adult
2 Adults
3 Adults
4 Adults
5 Adults
6 Adults
No Children
1 Child
2 Children
3 Children
4 Children
5 Children
6 Children
Spouse Name
Family Members
(
if Membership Type is other than Individual
Phone
Email
Address
Membership handling by:
indogram
- the global Indian village in your neighborhood™
