New Member

Charotar Leua Patidar Samaj (CLiPS)

Charotar * Kanam * Vakad * Daskoshi

(A non-profit Corporation established in 1990 – Federal ID #77-0264896)
P.O.Box 730034, San Jose, CA 95173

MEMBERSHIP APPLICATION FORM

Application For: • Life Member (One Time Fee of $251.00), • Patron (One Time Fee of $1,001.00)

First Name

Middle Name

Last Name

Spouse’s Name

Native Patidar Gaam

Spouse’s Gaam

Primary Cell

Secondary Cell

Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email Address

Spouse’s Email Address

List only Immediate Family Members in Order (retired parents, children under 21 years can be covered under your membership).Please Note – Son and/or Daughter with 21 year of age or older must apply for their own lifetime membership separately. They will not be able to enjoy member benefits under parents’ membership.

Name

Married (Yes/No)YesNo

Age

Relation to Primary Member

Occupation

PRESIDENT

Subhash Patel
Direct Contact

QUICK LINKS

CONTACT

Address
P.O.Box 730034, San Jose 95173

Contact
Email: info@clipsbayarea.com
Phone: 831 247 0948