Jain Digest 2005 07

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

Page 28

MIS REGISTRATION FORM - PAGE 1
Name (please print):
Address:
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, 304 Tall Oak Trail Tarpon Springs, FL 34688-7711 Phone: 727-934-6141 / 3255 hasmukh33@yahoo.com
STREET
Phone: ().
Date of Birth:
Are you a vegetarian?
YES
NO
Have you been married before? YES
LAST
Candidate's signature:
Fax: ().
Height:
If yes, indicate the name of your divorced spouse..
Your visa status in the USA/Canada?
CITY
FIRST
Email:
Weight:
Do you smoke? YES NO
NO
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
COMPANY'S NAME POSITION DURATION
Father's Name:
Mother's Name:
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):
STATE
When did you enter the USA/Canada? What is your religion?.
Occupation: Occupation:
26 JAIN DIGEST⚫ SUMMER 2005
MIDDLE
Do you drink? YES NO
Date:
ZIP
IMPORTANT CONSIDERATIONS:
It is important to remember that the MIS is a non-for-profit, voluntary community service. The MIS and JAINA assume no responsibility 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.
MONTH/YEAR