Tax

Identification #36-2960492 P.O. Box 267 Westmont, IL 60559

Advanced Registration Form for FAMILY PICNIC

You are cordially invited for Gujarati Samaj Chicago's (GSC) for a Family Picnic. The details of the event are as follows: Date: Time: Location: Registration Deadline: Mail Check to: Sunday July 14th, 2013 11:30 am to 7:00 pm Cook County Forest Preserve Northwest Busse Grove# 24
(Located on Higgins Road, Less than 1/2 mile East of 290, East of Route 53)

July 6th, 2013 Make check payable to: Gujarati Samaj Chicago Attn: Deepen Modi (Treasurer) or Attn: Suryakant Patel (President) 2455 Vicki Lane 6816 Fieldstone Drive Northbrook, IL 60062 Burr Ridge, IL 60527

Please mail the following details along with the check. Name: Address: Phone Number: Description Kids under 5 years: GSC Members: Non-Members: Price Free $ 5.00 each $ 8.00 each X X X email: No. of People Attending __________________= __________________= __________________= Total Free __________________ __________________ Membership No.:

Total Amount Enclosed: $___________________ AFTER JULY 6th , 2013 REGULAR PRICES WILL BE: GSC Members: $ 8.00 each Non-Members: $ 10.00 each
For any questions related to the event, please contact any of the following board members:
President Suryakant Patel: (708) 955-4966 General Secretary Jayesh Parikh: (847) 340-8470 Cultural Secretary Manish Pandya: (630) 965-2225 JT Treasurer Sandip Shah: Board Member Vibha Dave: Board Member-Maulin Parikh : Past President Mukesh Shah: (847) 303-6915 (630) 379-9527 (847) 962-0171 (847) 715-9257 Vice-President Kamlesh Shah: (630) 789-2487 JT General Secretary Bhavesh Shah: (847) 219-4241 Treasurer Deepen Modi: (312) 320-0988 Board Member Ashok Shah: Board Member Payal Shah: Board Member-Umang Shah: Board Member-Dakshesh Modi : (630) 659-7525 (630) 347-9046 (224) 723-4287 (630) 306-7149

For more information, don't forget to visit our website at www.gujaratisamajchicago.com or visit us on Facebook at www.facebook.com/gujaratisamajchicago .

Revised 06/10/13