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 |
FOR GSOD OFFICIAL USE ONLY:
| Payment for 2025 Gujarati Samaj, Inc. Membership received: Secretary: | ||||||||||||
| Date Form Received: | Check Amount: $ | Check Date: | Check #: | |||||||||
Membership
form also available on www.GSOD.org
