Greater Washington Telugu Cultural Sangam (GWTCS)
A Maryland Non-profit Organization IRS EIN: 541-54-8277
http://www.gwtcs.org

Date: ______________      

New Membership Renewal Change of Address

Note: All the information in Bold Font is required

Last Name: _______________________ First Name: _________________________

Address:______________________________________________________________

City: _____________________________ State: _________ ZIP: ________________

Phone(with area code) _________________________________ Email: ________________________

Spouse Name: __________________________________________________________

Family Members: ________________________________________________________

Membership Info:

Regular: Package for One Year:
Single $10.00 Single XXXX
Double $15.00 Double XXXX
Family $20.00 Family XXXX
Student $6.00

Regular Life Membership $100.00 (One Time only)

Payment: Check (payble to GWTCS)   Cash    Other (No credit cards)

Comments:________________________________________________________________
________________________________________________________________________
Signature of the Member: 
________________________________________________________________________
Mail the Form to
Greater Washington Telugu Cultural Sangam
Pradeep Nugooru
Treasurer For GWTCS
12985 AZALEA WOODS WAY
Herndon VA 20171