Membership Form

We urge every KOJAIN family to submit the duly completed form to maintain KOJAIN Database. Help us make the database as complete as possible. Thank you for your support and cooperation.

We encourage you to join KOJAIN organization as a life member. Please make your check payable to KOJAIN

Please print this form once you have entered the data and mail the form along with your check to the Treasurer of KOJAIN:
Piyush J. Vora, 603 Morehouse Hwy, Fairfield, CT 06825
Tel: 203-967-3807 (email: piyushvora@hotmail.com)

First Name: *

Last Name: *

Middle Name: *

Email: *

Phone: *

Occupation: *

Village in Kachchh: *

Spouse - First Name:

Spouse - Email:

Spouse - Phone:

Spouse - Occupation:

Spouse - Village in Kachchh (Before Marriage):

Home Address - Street:

Home Address - City:

Home Address – State, Zip Code & Country:

Child 1 Name:

Child 1 Year Born (if married do not enter year born):

Child 2 Name:

Child 2 Year Born (if married do not enter year born):

Child 3 Name:

Child 3 Year Born (if married do not enter year born):

Membership Type: *

Family Life Membership $250

Family 2-year membership $40

Individual Life Membership $200

Individual 2-year membership $30

Disclaimer: Reference in this web site of any off-site web link does not constitute its endorsement or recommendation by KOJAIN. KOJAIN is not responsible for the contents of any off-site web page referenced from this server. KOJAIN assumes no responsibility or liability for the accuracy or authenticity of the information furnished in the off-site web page or any consequences resulting thereof. The entire responsibility rests with the readers themselves.

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