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Charotar Leua Patidar Samaj
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Register
Application For:
Life Member ($251)
Patron ($1001)
Native Patidar Gam:
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Last
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Address Line 2
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Occupation:
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Other Family Members LIVING with You
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Married
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Relation
Occupation
Name
Birth Date
Married
Yes
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Relation
Occupation
Name
Birth Date
Married
Yes
No
Relation
Occupation
Name
Birth Date
Married
Yes
No
Relation
Occupation
Name
Birth Date
Married
Yes
No
Relation
Occupation
Total
$ 0.00
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Terms and Conditions
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I agree
Life Member must be a Patidar from Native Gam in Charotar, Kanam, Vakad or Daskoshi regions from Gujarat, India. Life Membership of a qualified Patidar Family includes Primary Member, his/her spouse, their children, parents and brothers & sisters (below 21 years of age) living with the family as a one family unit. Brothers and sisters over 21 years of age must become a separate member unless a person is disabled.
Patron Membership includes anyone other than a qualified life member(s) as defined above who is a friend and supports the CLiPS Samaj goals and objectives with limited rights and privileges per the Samaj by-laws. Patron can be a single entity, business or an individual and his/her spouse and children living with the Patron.
I hereby apply for the membership of the Charotar Leua Patidar Samaj (CLiPS) and pledge to abide by all the Articles of Incorporation and by-laws of the CLiPS, also known as (AKA) the Patidar Samaj. Neither the Patidar Samaj or its board members including trustees nor the facilities rented by the Samaj is liable for any kind of personal and/or property damages to me or any of my family members or (invited or uninvited) guests.
I certify that the information supplied above is correct and complete to the best of my knowledge. I also, authorize the Patidar Samaj to release and publish the above family information in any future Patidar Samaj Publication(s).
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