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TVKS Member Profile Form

Application For: ____ Family Member ($25/yr) ______ Single ($20/yr) First Name Primary Member email Spouse email Child 1 Child 2 Other 1 Other 2 I hereby apply for the membership of the Tri Valley Kannada Sangha (TVKS) voluntarily. I acknowledge that neither Tri Valley Kannada Sangha or its board/core members including trustees, nor the facilities rented by TVKS is liable for any kind of personal and/or property damages to me or any of my family members or (invited or uninvited) guests. I certify that the information supplied above is correct and complete to the best of my knowledge. _______________________________ Primary members Signature ______________________________ Spouse's Signature Last Name Age Home Phone Cell Phone

For TVKS use Amount Paid: Date:

Check Number: Membership Year: