________________
A/C/F/M
Send this completed form, a check in the amount of $25.00 and a recent, full-length photograph of yourself with your name printed on the back to: Hasmukh M. Shah, 8721 Scrimshaw Drive, New Port Richey, FL 34653.
Name: (Please Print).
Address:
Education:
Marriage Information Service Registration Form - page 1
Federation of Jain Associations In North America.
Phone: ( )
Date of Birth:
Are you a vegetarian? yes no
Have you been married before? yes no If yes, indicate the name of your divorced spouse.
What is your Visa status in the USA/Canada?
What languages do you speak?
What languages do you read?
What languages do you write?
Work experience:
Father's Name:
Degree
Street
Mother's Name:
Brother(s) and/or Sister(s).
Jal March 1997mational
Last
Candidate's signature:
Fax: (
Company's name
Year received
City
)
Name(s)
Age(s) Do you have other relatives living in the North America?
First
Height:
Weight:
Do you smoke? yes no Do you drink?
Major
Position
Occupation:
Occupation:
Other relevant information (use additional paper if necessary):
State
When did you enter the USA/Canada? What is your religion..
Education
Name Relationship
Middle
E-mail:
ForJAIN DIGEST se Only
yes no
Name of University
Duration
Zip
Occupation
Occupation
Date:
The MIS and JAINA assume no liability or responsibility for the accuracy or authenticity of the information herein, nor the consequences resulting thereof.
month/year
Address
www.jainelibr.org
