________________
Name: Dr. / Mr./Mrs./Miss./Ms.:
Name of Spouse: Dr. / Mr./Mrs.:
Home Address:
City:
Home Phone Number:
Profession:
Information for 1996 update of the Jain Directory
Send to: Jain Center of Greater Boston 26 Humbolt Avenue Burlington, MA 01803 Phone 617/272-3666
Name of Company:
Office Phone Number:
Spouse's Profession:
Name of Company:
Office Phone Number:
Name
Please check one: Correction: Addition: New Entry: PLEASE TYPE OR PRINT CLEARLY
Signature:
State:
Fax:
May 1996
Jain Education International
Fax:
Fax:
State:
Residence in India: City:
Please list other family members living at this address including students who are living away from home. Please fill out a seperate form for each married couple.
Relationship
Zip:
E-Mail:
Date:
E-Mail:
If you would you like to place an advertisement in the Directory please send all appropriate information to the address indicated above. Included in this Directory will be a NEW listing of all Jain businesses. If you would like your place of business included in this NEW section, please send all appropriate informtion to the address indicated above. Feel free to duplicate this form and pass it on to your Jain Friends.
JAIN DIGEST
For Personal & Private Use Only
E-Mail:
Submission of this form by the undersigned constitutes permission for the Jain Center of Greater Boston to publish the information there in, 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.
Year of Birth
5
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