Jain Digest 2005 11

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

Page 36

ZIP
MIS REGISTRATION FORM - PAGE 1
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 Name (please print): - LAST FIRST
MIDDLE Address: STREET
CITY
STATE Phone: () _ Fax: ()
Email: Date of Birth:
Height:
Weight: Are you a vegetarian? YES NO Do you smoke? YES O NO Do you drink? O YES NO Have you been married before? YES ONO If yes, indicate the name of your divorced spouse. Your visa status in the USA/Canada? When did you enter the USA/Canada?
MONTH/YEAR What languages do you speak?
What is your religion? 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:
Occupation: Mother's Name:
Occupation: 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):
Candidate's signature:
Date:
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.
Jain 18
WINTER 2005
For Private & Personal Poroinfo on 2005 convention log on www
jainacorg