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International Hindi Association

A NON-PROFIT ORGANIZATION ●● ●● ● 2129 Stratford Road, Murfreesboro, TN 37129
● ● ● ● ● TAXID 58-1988753 ● ●● ● Founded by Late Dr. Kunwar Chandraprakash Singh in 1980
●
PASSPORT SIZE
MEMBERSHIP FORM ‚ŒSÿÃÊ •ÊflŒŸ-¬òÊ PHOTOGRAPH
(PLEASE PRINT IN CAPITAL LETTERS)

©U¬ŸÊ◊ ŸÊ◊ Last Name ....................................................................................……..................................................
¬˝Õ◊ ŸÊ◊ First Name ......................................................................................……...................................................

¡ËflŸ‚ÊÕË ©U¬ŸÊ◊ Spouse’s Last Name: ………..……………………..................................................................................................................................
¬˝Õ◊ ŸÊ◊ First .............................................……………………………………………………...............................................................................................

¬ÃÊ Address:……................................................……………………………..…..……………...............................................................................................
‡Ê„U⁄U City: .…………….…………………..….............……¬˝Ê¥Ã State: …..…….......................……………∑§Ê«U Postal Code: .……...…...............….............

⁄UÊc≈˛U Country: ……….…………………….................…...............…................................................................................................................…...…………
ŒÍ⁄U÷Ê· Home Phone : ………….……….......……. Work Phone: ……...….............……..……….…… Mobile Phone: ........................................….............
߸U-◊‹ E-mail: …………………………………..…………………….……….…………………….................................................…...............…....................
Introduced by: Name…………….………..........................Phone………………..…...............….............……Email……………..…………….…................

∑Χ¬ÿÊ ∑§Ê߸U ∞∑§ Áfl∑§À¬ øÈŸ¥ Please check one of the following :

ÁŸÿÁ◊à •Ê¡ËflŸ Regular Life Member: $250 USD Rs 16000 INR in Indian subcontinent
ÁŸÿÁ◊à flÊÁ·¸∑§ Regular Annual Member: $35 USD Rs 2300 INR in Indian subcontinent
‚¥’h •Ê¡ËflŸ Associate Life Member: $150 USD Rs 9500 INR in Indian subcontinent
‚¥’h flÊÁ·¸∑§ Associate Annual Member: $25 USD Rs 1600 INR in Indian subcontinent
‚¥SÕÊ flÊÁ·¸∑§ Annual Institutional: $50 USD Rs 3300 INR in Indian subcontinent
Please make check or bank draft payable to ‘International Hindi Association’ in USD and mail to:
Kiran Khaitan, 203 Cheltenham Lane, Munroe Falls, OH 44262, USA; Phone: (330) 622-1377; Email:treasurer@hindi.org
In India, please make check or bank draft payable to ‘International Hindi Association, India chapter’ and mail to:
Mr. Shiv Kumar Meharia, S.K. Agencies, E5 City Center, Bokaro Steel City, Jharkhand 827004; Phone:+919431127573;
Email: treasurerindia@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.
6. Associate Membership provides all the benefit except the voting right. For details, go to the www.hindi.org.
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: editor@hindi.org / joshikavirai@gmail.com
Visit www.hindi.org to contact us or for additional information.
For Official Use only:
Assigned Member Id: …………………………………….Signature ………………………………….REVISED JULY 2016