Jain Digest 1996 04

Author(s): Federation of JAINA
Publisher: USA Federation of JAINA

Page 23

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:
Phone: ()
Date of Birth:
Marriage Information Service Registration Form
Federation of Jain Associations In North America
Height:
Are you a vegetarian? yes no Do you smoke? 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?
Education:
Work experience:
Father's Name:
Street
Degree
Last
Mother's Name:
Brother(s) and/or Sister(s)
May 1996
Candidate's signature:
Year received
Company's name
City
Name(s)
Age(s) Do you have other relatives living in the North America?
First
Fax: ()
Weight:
Do you drink? yes no
What is your religion.
Major
When did you enter the USA/Canada?
Position
Occupation:
Occupation:
Other relevant information(use additional paper if necessary):
State
Education
Name Relationship
Middle
JAIN DIGEST
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
21