PALM BEACH HINDU MANDIR

16060 Okeechobee Blvd, Loxahatchee Groves, FL 33470

Membership Application Form*, **, ***

 

Name

(Last, First, M.I.)

 

Address

 

 

 

Zip (Postal) Code

 

Contact Phone#

 

Mobile Phone#

 

E-Mail  Address

 

 

Additional Information

(Please list here any special skills, talents, qualifications, knowledge, and expertise that you possess, as well as your interest and availability (time) that you can contribute to the temple.)

 

 

 

 

 

 

 

Signature

 

 

Date

 

*Annual Membership Fee: $50.00 (Per Family);  Membership is Non-Transferable.

** Palm Beach Hindu Mandir, Inc. is a 501 (c) 3 Tax-Exempt Organization,  and all donations made to the temple are tax-deductible.

*** Please fill out the above form, print it, and mail to Palm Beach Hindu Mandir, Inc., 16060 Okeechobee Blvd., Loxahatchee Groves, FL 33470, along with your check, payable to PBHM or Palm Beach Hindu Mandir.

 

Thank You For Completing and Mailing This Application Form and For Showing Your Interest In Becoming a Member of PBHM!