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

For Year 2007 ( Jan 2008 to December 2008 )
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:
Single $10.00 Single $40.00
Double $15.00 Double $65.00
Family $20.00 Family $85.00
Student $6.00

Regular Life Membership $150.00
      (Special Membership drive $100.00 until Ugadi 2008 function)

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

Comments:________________________________________________________________
________________________________________________________________________
Signature of the Member: 
________________________________________________________________________
Mail the Form to
Greater Washington Telugu Cultural Society
Goapal Bobba
Treasurer For GWTCS
23523 Forest Haven Way
Clarksburg, MD 20871