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MIS REGISTRATION FORM -PAGE 1
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
LAST
YEAR
What languages do you speak?
What languages do you read?
What languages do you write?
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?
Fax: ()
Height:
Candidate's signature:
FIRST
CITY
Weight:
Do you smoke? YES NO
MIDDLE
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
Email:
When did you enter the USA/Canada?
Do you drink? YES NO
Education:
DEGREE YEAR RECEIVED MAJOR NAME OF UNIVERSITY/COLLEGE
Work experience:
Occupation: Occupation:
What is your religion?
Date:
ZIP
MONTH/
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.
Jain Education International.
For Private & Personal Use Only
www.jainelibrary.org
