INTERNATIONAL JAIN SANGH, INC.

(Non-profit tax-exempt organization. Fed. ID 22-3655912 )

3 Deerpath Drive,

Farmingdale,

NJ 07727, NJ 07712

Tel: (732) 493-0093

MEMBERSHIP APPLICATION

Date:                                                                                                                 (Please Print)

I hereby apply for membership in International Jain Sangh :

Last Name: __________________________________

First Name:___________________________________

Family member’s names( spouse, son, daughter, parent)

___________________________________________

____________________________________________

____________________________________________

____________________________________________

Address: ______________________________________

______________________________________

______________________________________

Home Tel.: ___________________________________

Home Fax: ___________________________________

Work Tel.: ___________________________________

Work Fax: ___________________________________

E-MAIL: _______________________________________

Enclosed are the membership dues.

[  ] $25           Annual membership

[  ] $251         Life membership

_______________________

Signature

Enclosed is my donation:  1. $25.___2. $51___   3. $101___4. $251____5.  $501___6. Other_____.   Please use my donation for the Purpose of______________________