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Information for 1996 update of the Jain Directory
Send to: Jain Center of Greater Boston
26 Humbolt Avenue
Burlington, MA 01803
Phone and Fax 617/272-3666 Please check one: Correction, Addition, New Entry
PLEASE TYPE OR PRINT CLEARLY
Name: Dr. / Mr./Mrs. / Miss. / Ms.:
Name of Spouse: Dr./Mr./Mrs.:
Home Address:
City:
State:
Zip:
Home Phone Number:
Fax:
E-Mail:
Profession:
Name of Company:
Office Phone Number:
Fax:
E-Mail:
Spouse's Profession:
Name of Company:
Office Phone Number:
Fax:
E-Mail:
Residence in India: City:
State:
Please list other family members living at this address including students who are living away from home. Please fill out a separate form for each married couple.
Name
Relationship
Year of Birth
Submission of this form by the undersigned constitutes permission for the Jain Center of Greater Boston to publish the information therein, in print, electronic database or other forms. In the event of error or omission, the Jain Center of Greater Boston will not be held responsible.
Signature:
Date:
Sept./Dec. 1995 Jain Education Intemational
JAIN DIGEST For Private & Personal use only
www.jainelibrary.org
