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अंतरा्चष्ट्ीय डहनदी सडमडत

                                         International Hindi Association
                                     A NON-PROFIT ORGANIZATION   2129 Stratford Road, Murfreesboro, TN 37129  PASSPORT SIZE
                                      TAXID 58-1988753   Founded by Late Dr. Kunwar Chandraprakash Singh in 1980
                                                                                          PHOTOGRAPH
                                       MEMBERSHIP FORM सदसयता आवेदन-्त्र
                                        (PLEASE PRINT IN CAPITAL LETTERS)






         उपिाम िाम  Last Name ....................................................................................…….....................................................................

         प्रथम िाम First Name ......................................................................................……......................................................................
         जीवि साथी का उपिाम Spouse’s Last Name: ………..……………………................................................................................................

         प्रथम िाम First Name......................................……………………………………………………......................................................................

         पिा Address:……................................................……………………………..……………...........................................................................
         शहर City: .…………….…………………..….............…… प्रांि State: …..…….......................……………कोड Postal Code: .……...…...............…..

         राष्ट्र Country: ……….…………………….................…...............…......................................................................................................

         दूरभाष Home Phone : ………….……….......……. Work Phone: ……...….............………….…… Mobile Phone: .....................................
         ई-मेल E-mail: …………………………………..…………………….……….…………………….................................................…...............…............

         Introduced by: Name…………….………..........................Phone………………..…............Email……………..…………….…............…. ....……
         कृ्या कोई एक डवकल् रुनें Please check one of the following :


                                   डनयडमत आजीवन Regular Life Member:             $250 USD
                                   डनयडमत वाड््चक Regular Annual Member:         $35 USD
                                   वया्ार/संस्ा वाड््चक Annual Institutional:     $500 USD

         Please make check or bank draft payable to ‘International Hindi Association’ in USD and mail to:
         Ranbir Kumar, 141-34 79th Ave, Apt 1B, Flushing, NY 11367, USA. Phone: (347) 665-7719; Email: treasurer@hindi.org
         Bank Name: …………………………………………………. Check / Draft No……………..……………… Date ………......................
         The membership provides the following benefits:
         1. A subscription of widely acclaimed quarterly literary magazine Vishwa published from the U.S. in Jan, April, July and Oct.
         2. Discounts on IHA products and services such as Hindi CDs, kavi sammelan, seminars, conferences, and youth-clubs.
         3. Rewarding volunteer opportunities in many valuable programs in the USA and India.
         4. Access to Member’s-only information, and prior notification of events.
         5. Regular Membership provides right to vote on matters of the Association after a waiting period of sixty days.
         The Board of Directors maintain the right to deny, suspend or cancel membership of any individuals who fail to abide by the Articles of
         Incorporation or the Bylaws or whose activities are deemed detrimental to the proper functioning of the Association. The Board is not
         obligated to refund any unused portion of the membership dues for cancelled membership.
         ‘Vishwa’ welcomes original writings in Hindi from all quarters. Writings dealing with immigrant experiences are especially welcome.
         For further information, or to submit your writings for consideration, please contact: The Editor, Mr. Ramesh Joshi, 10046 Parkland
         Drive,Twinsburg, OH 44087, USA. Phone USA +1 (330) 688-4927, India +91 94601 55700; Email: joshikavirai@gmail.com & editor@
         hindi.org
                                   Visit www.hindi.org to contact us or for additional information.

         For Official Use only:
         Assigned Member Id: …………………………………….      Signature ………………………………….                    REV JAN 2019
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