Annual Membership Form
Chicago & Hyderabad
Student of Osmania University
Indian & US official Link
Hyderabad & Chicago Media Link
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.
Suite # (P.O Box)
Signature (Head of the Family)
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.
HA USE ONLY
Total Number of Members
Date of Membership Received
Personal Check / Money order #
Total Membership fee Received $
Received Personal Check / Money order/Cash
Membership Status Good Standing/ Renewal/Expired
Membership form and dues Received by
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
Please fill out the Annual Membership Form online & pay by the credit card. If pay by check Payable to
Please send print out of your form along with check at the following address.
P.O. Box, 68872, Schaumburg, IL- 60168: 224-634-5159