________________ Federation of JAINA Young Jains of America Committee 1993 - 1994 Membership Form Please complete the following membership form if you are within the ages of 14-29 and are interested in joining YJA - Young Jains of America. Send the completed forms to: Anil Jain, Director of Membership - YJA, 758 Brookside Circle, Elmira, NY 14903. __M.I. परस्परोपग्रहोजीवनाम् Lined Let L Member I.D. (Zone - Number; YJA use only): General Information: Today's Date: Last Name: First Name: Permanent Address: City: State: Zip Code: Current Electronic Mail Address (if applicable): Home Telephone Number: ( ) Home Fax Number: ( Date of Birth (MM/DD/YY): ___Jain Ctr. Affiliation: Married? Yes No If Yes, Spouse's Name: Parents' Names: Date of Birth (MM/DD/YY) of Spouse: ) High School Information: High School Name: Check if currently a high school student Class of WORS College Information: Check if currently a college student 0 University College: _Class of: Most Recent (or current) Degree/Major: Previous Degrees/Majors and/or Schools Attended: Ww X8060 Current College Address: Valid Un Current College Telephone Number (if applicable): ( ) 30 with Young Professional Information: Profession (list primary field(s)): Employer/Company: Position/Job Title Business Address: 0988 Bus. Telephone Number: ( ) Number RUS BUSSOS : I do not want: Any of this information published in an opeomme YJA directory My home college business phone number(s) published, 22 JAIN DIGEST MARCH 1994 Jain Education International 2010_02 For Private & Personal Use Only www.jainelibrary.org
