________________
MIS REGISTRATION FORM - PAGE 1
Name (please print):
Address:
STREET
Phone: ()
Date of Birth:
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 Phone: 727/376-7290
LAST
Fax: ()
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?
MONTH/YEAR
Candidate's signature:
Height:
22/ JAIN DIGEST WINTER 1999
COMPANY'S NAME POSITION DURATION
Father's Name:
Mother's Name:
Jain Education International 2010_02
FIRST
Weight:
Do you smoke? YES NO
CITY
Brother(s) and/or Sister(s)
NAME(S) AGE(S) EDUCATION OCCUPATION
Do you have other relatives living in the North America? NAME RELATIONSHIP OCCUPATION ADDRESS
Other relevant information (use additional paper if necessary):
MIDDLE
What languages do you speak?
What languages do you read?
What languages do you write?
Education:
DEGREE YEAR RECEIVED MAJOR NAME OF UNIVERSITY/COLLEGE
Work experience:
Occupation: Occupation:
STATE
When did you enter the USA/Canada?
Email:
Do you drink? YES NO
For Private & Personal Use Only
What is your religion?
Important Considerations:
It is important to remember that the MIS is a non-for-profit, voluntary community service. The MIS and JAINA assume no respon-sibility or liability for the accuracy or authenticity of the information furnished in the ads or any consequences resulting thereof. The entire responsibility rests with the candidates themselves. All information furnished to the MIS is confidential. Only those who are sincerely interested in looking for a Jain life partner should send a Registration Form. While matching, photographs will not be passed on to the candidates by the MIS. Parents/guardians should communicate with the candidate before placing ad and assist them in making a final decision.
Date:
ZIP
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