World Malayalee Council

WASHINGTON DC PROVICE PO BOX 588, Ashton, MD 20861

Price $25.00 now.

Membership Renewal once in Two Years

I wish to become a Biennial Member of WORLD MALAYALEE COUNCIL(WMC)

Details about myself and my family are given below:

APPLICANT

SPOUSE

Household/Children Information

NAME

RELATIONSHIP

AGE

YOUR CURRENT INFORMATION

ADDRESS

OFFICE

HOME PHONE

CELL PHONE

E-mail

CREATE PASSWORD

Confirm CREATE PASSWORD

HOME COUNTRY INFORMATION

CITY/VILLAGE

DISTRICT

TALUK

STATE

Additional information (optional)

I hereby certify that the information given above is true and complete to the best of my knowledge.

I agree to abide by all the terms and conditions of the association.

DATE

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