Jain Digest 2006 07 Vol 24 No 3

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

Page 28

MIS REGISTRATION FORM -
MIS REGISTRATION FORM - PAGE 1
Name (please print):
Address:
STREET
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
LAST
Candidate's signature:
Fax: ()
FIRST
Phone: ()
Date of Birth:
Are you a vegetarian? YES NO
Have you been married before? YES NO
If yes, indicate the name of your divorced spouse.
Your visa status in the USA/Canada?
YEAR
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:
Height:
CITY
Weight:
Do you smoke? YES NO
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):
MIDDLE
STATE
Occupation: Occupation:
When did you enter the USA/Canada?
Email:
Do you drink? YES NO
What is your religion?
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 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.
MONTH/
26/JAIN DIGEST Spring 2005 www.jainelibrary.org