Gujarati
Samaj of Detroit - 2023 Membership Form
Membership effective from January 1, 2023
to December 31, 2023
MEMBERRSHIP RENEWAL
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LIFE MEMBERSHIP – UPDATE INFO
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Renew my membership based on last
year’s profile.
Provide your Member ID here:
Please complete Sections 1 & 3 below.
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I am a
Life Member; please change/update my information.
Provide your Member ID here:
Please complete Sections 2 & 3 below.
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Member Email Address: _____________________________________________
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SECTION 1: MEMBERSHIP
CATEGORIES & FEES
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Family Membership
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Husband, wife, unmarried children under 25 years of age,
and parents living in the same household. Due Date for Renewal is May 31, 2023.
Please note:
Membership renewal fee
will be $50 after May 31, 2023.
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$50
NEW MEMBER or
RENEWAL after 5/31/23
$50
RENEWAL
(before 5/31/23)
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Single Membership
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Single as defined by IRS (Only one person is allowed)
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$25
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Senior Membership
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One spouse is 62 years of age or above (Only two person
are allowed)
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$25
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Life Membership
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Lifetime affiliation with Samaj
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$751
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Corporate Membership
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Corporate Membership
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$101
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SECTION 2: MEMBERSHIP INFORMATION
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Member’s Full Name:
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Age:
yrs
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Spouse’s Name:
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Age:
yrs
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Child Name:
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M / F
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Grade:
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Age: yrs
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Child Name:
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M / F
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Grade:
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Age: yrs
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Child Name:
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M / F
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Grade:
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Age: yrs
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Child Name:
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M / F
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Grade:
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Age: yrs
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Father’s Name:
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Age:
yrs
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Mother’s Name:
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Age:
yrs
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Street Address:
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City:
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State: MI
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Zip:
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Telephone
(required):
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Email:
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Gujarati Samaj, Inc. will maintain address
and e-mail information with strict confidence and will not use / give it to
others for solicitation.
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SECTION 3: ACKNOWLEDGEMENT & AUTHORIZATION
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I,
undersigned
understand that this membership application will be reviewed by Secretary of
Gujarati Samaj, Inc. I also understand that the membership fees are
non-refundable. The above information is true and correct to the best of my
knowledge. I understand that any misrepresentation or falsification will
result in the cancellation of my membership and I will be responsible for
non-member fees if the membership was used during any of Samaj’s events, such
as Holi, Navratri, Diwali and other events. By providing the contact
information above, I understand that GSOD may communicate with me via phone,
e-mail or USPS.
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SIGNATURE:
______________________________________
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DATE: ___________
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Please Make Check Payable to: Gujarati Samaj, Inc.
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Form & Check Mailing Address: G.S.O.D.,
C/o Sarthak Patel 4310 Pond Run, Canton, MI 48188
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Questions? Please send an e-mail to
Secretary@GSOD.org
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FOR GSOD OFFICIAL USE ONLY:
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Payment for 2023 Gujarati Samaj, Inc. Membership received: Secretary:
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Date Form Received:
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Check Amount: $
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Check Date:
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Check #:
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Membership
form also available on www.GSOD.org