Jain Digest 1998 04

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

Page 33

MIS REGISTRATION FORM-PAGE 1
Name (please print):
Address:
Phone: ( )
Date of Birth:
Are you a vegetarian? YES
Education:
Send this completed form, a check in the amount of $25 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 34653-6623
What languages do you speak?
What languages do you read?
What languages do you write?
Work experience
Father's Name:
STREET
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?
DEGREE
Mother's Name:
Brother(s) and/or Sister(s)
LAST
Candidate's signature:
Height:
Do NO
you
COMPANY'S NAME
Fax: ( )
YEAR RECEIVED
NAME(S)
CITY
smoke? YES
Do you have other relatives living in the North America?
AGE(S)
FIRST
Weight:
NO
MAJOR
POSITION
Other relevant information (use additional paper if necessary):
Do you drink? YES NO
Occupation:
Occupation:
When did you enter the USA/Canada?
What is your religion?
NAME
STATE
EDUCATION
Email:
MIDDLE
RELATIONSHIP
NAME OF UNIVERSITY/COLLEGE
ZIP
DURATION
OCCUPATION
OCCUPATION
Date:
MONTH/YEAR
The MIS and JAINA assume no liability or responsibility for the accuracy or authenticity of the information herein, nor the consequences resulting thereof.
ADDRESS
JAIN DIGEST SUMMER 1998/31