Membership Form

Gujarati Samaj of Detroit - 2025 Membership Form

Membership effective from January 1, 2025 to December 31, 2025

PayPal Link: https://www.paypal.com/ncp/payment/9SMQH9CW7W65W

Or use this Form

MEMBERRSHIP RENEWAL

LIFE MEMBERSHIP – UPDATE INFO

Renew my membership based on last year’s profile.	Please complete Sections 1 & 3 below.	I am a Life Member; please change/update my information.	Please complete Sections 2 & 3 below.
Member Email Address: _____________________________________________
SECTION 1: MEMBERSHIP CATEGORIES & FEES
Family Membership	Husband, wife, unmarried children under 25 years of age, and parents living in the same household. Due Date for Renewal is May 31, 2024.	Please note:	Pay Before May 31st for Voting rights.	$50 One year	$100 Three year
Single Membership	Single as defined by IRS (Only one person is allowed)	$25	Pay Before May 31st for Voting rights.
Senior Membership	One spouse is 62 years of age or above (Only two person are allowed)	$25	Pay Before May 31st for Voting rights.
Life Membership	Lifetime affiliation with Samaj	$751	Pay Before May 31st for Voting rights.
Corporate Membership	Corporate Membership	$101

SECTION 2: MEMBERSHIP INFORMATION

Member’s Full Name:	Age: yrs
Spouse’s Name:	Age: yrs
Child Name:	M / F	Grade:	Age: yrs
Child Name:	M / F	Grade:	Age: yrs
Child Name:	M / F	Grade:	Age: yrs
Child Name:	M / F	Grade:	Age: yrs
Father’s Name:	Age: yrs
Mother’s Name:	Age: yrs
Street Address:
City:	State: MI	Zip:
Telephone (required):		Email 1:	Email 2:
Gujarati Samaj, Inc. will maintain address and e-mail information with strict confidence and will not use / give it to others for solicitation.

SECTION 3: ACKNOWLEDGEMENT & AUTHORIZATION

I, undersigned understand that this membership application will be reviewed by Secretary of Gujarati Samaj, Inc. I also understand that the membership fees are non-refundable. The above information is true and correct to the best of my knowledge. I understand that any misrepresentation or falsification will result in the cancellation of my membership and I will be responsible for non-member fees if the membership was used during any of Samaj’s events, such as Holi, Navratri, Diwali and other events. By providing the contact information above, I understand that GSOD may communicate with me via phone, e-mail or USPS.

SIGNATURE: ______________________________________

DATE: ___________


Please Make Check Payable to: Gujarati Samaj, Inc.
Form & Check Mailing Address: G.S.O.D., C/o Satish Shah 43284 Westphalia Ct, Sterling Heights MI 48314
Questions? Please send an e-mail to	Secretary@GSOD.org