Bay Area Prabasi Online Membership Form

Title and Name :
First: Middle: Last:
Home Telephone Number :
Daytime Telephone Number : (optional)
Address Line 1 :
Address Line 2 : (optional)
City : State : ZIP : -
Membership Type :

Do you want to enroll your spouse as a member? Yes No (I just want a single membership)
Full name of spouse : (only if you answered Yes above)
Number of Children : (age 3 years or less) (age more than 3 years)
(Membership is free for children below 3 years, but this is needed for head-count)
Are your parents included :
Your company name :
We depend a lot on matching donations from your company to meet our needs. By specifying your company name, we can approach your company to get an equivalent donation. Your cooperation is highly desirable.
Number of Guests :
Email Address(es) : (separated with commas)

You must supply your correct Email address because we will send you your password through Email only.

Comments (if any) :

Important Clarification: Prabasi does not generally have a pro-rated membership system. Our membership is for one year and starts on July 1st and ends on June 30th of the following year. Membership renewal usually begins before Durga Puja. Becoming a member at the beginning of our fiscal year is always good for the member and helps the Board to prepare Prabasi's yearly budget.