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Jain Senior Group Registration Form
1 registration form per member.
No annual fees, but will have minimum fees depending on the event.
At least 1 member should be over 55 years of age in the couple.
C
ontact: Manna Shah 240-498-6183
Shilpa M. Shah 410-292-0814
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First Name
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Your answer
MI :
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Last Name :
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Your answer
Date of Birth :
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MM
/
DD
/
YYYY
Address 1 :
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Address 2 :
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City :
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State :
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Zip Code :
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Mobile #
:
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Email Address :
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Emergency Contact Information ( A person who is NOT your spouse)
First Name :
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MI :
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Last Name :
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Relationship :
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Mobile # :
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Email Address :
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Other Details --
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Are you Vegan ?
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