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Online Membership
Please pay the membership dues as and when you are notified.
Name (Head of the Family)
Spouse Name (Optional)
Children’s Name (Optional) All Children’s of above 18 years of age must fill separate membership form.
Gender
Male
Female
Children’s Name
Home Address
Number
Zip Code
Suite # (P.O Box)
E-mail
Street
Cell
City
Phone
State
Referred by
Name
E-mail(*)
Cell
Signature (Head of the Family)
Phone Number
Date (MM – DD – YYYY)
I certify that all the information that was provided by me in this form is true to the best of my knowledge. I also hereby authorize Hyderabad Association to publish my name, address, home phone, and cell/work phone on the Hyderabad Association web site and in the Hyderabad Association Directory.
Yes
No
(Optional)
HA USE ONLY
Membership Verification
Membership Number
Total Number of Members
Date of Membership Received
Membership Since
Personal Check / Money order #
Total Membership fee Received $
Received Personal Check / Money order/Cash
Membership Expired
Membership Status Good Standing/ Renewal/Expired
Membership form and dues Received by
Signature
Date
Annual Membership Amount:
Please Select Membership Plan
Family Membership - 50.00 USD
Senior Single - 20.00 USD
Single Membership - 30.00 USD
Senior Citizen Couple - 35.00 USD
Student Membership (over 18 years of age) - 20.00 USD
Donation - 10.00 USD
Life time Membership - 100.00 USD
send now
Please fill out the Annual Membership Form online & pay by the credit card. If pay by check Payable to
Hyderabad Association
Please send print out of your form along with check at the following address.
Hyderabad Association
P.O. Box, 68872, Schaumburg, IL- 60168: 224-634-5159