World Malayalee Council

WORLD MALAYALEE COUNCIL

WASHINGTON DC PROVINCE PO BOX 588, Ashton, MD 20861

Donate $50.00 now.

Membership needs to be renewed after 2 years

I wish to become a Biennial Member of WORLD MALAYALEE COUNCIL-DC province

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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