JSGA New Member Form

New Member Form

Ways you can help Jain Society Of Greater Atlanta (JSGA)
Choose Membership Type

Life Membership ($501)Annual Membership for calendar year ($101)Single' Membership for calendar year ($51)
JSGA Lifetime Member Reference*
Provide existing Lifetime Member Name & Contact Info who can refer you
Name of Primary Member*

First NameMiddle NameLast Name
Birth Month of Primary Member*
Birth Year of Primary Member*
E-mail address Primary Member*
example@example.com
Gender*

MaleFemale
Phone Number of Primary Member*
(country-code)+(Area-code)+(phone Number)
Your occupation (optional)
Home Address*
Address Line 1
Address Line 2
City*
State*
zip*
Hometown in India
Do you want to include Address in Member Directory?

YesNo
Marital Status?*

SingleMarried
Childrens (if any)*

None123
Spouse Information >

Enter Spouse information
Spouse Name*

First NameLast Name
Include Spouse name in Directory ?*

YesNo
Spouse Email Address*
example@example.com
Spouse Mobile Number*
(country-code)+(Area-code)+(phone Number)
Do you wish to provide spouse's occupation information?

YesNo
Spouse Occupation*
Children/s Information >

child must be under 21 and unmarried
Check this box if you wish to include children's information in Member Directory
Child-1 Name*

First NameLast Name
Birth Month
Birth Year
child must be under 21
E-mail address
example@example.com
Mobile number
(country-code)+(Area-code)+(phone Number)
Child-2 Name*

First NameLast Name
Birth Month
Birth Year
child must be under 21
E-mail address
example@example.com
Mobile number
(country-code)+(Area-code)+(phone Number)
Child-3 Name*

First NameLast Name
Birth Month
Birth Year
child must be under 21
E-mail address
example@example.com
Mobile number
(country-code)+(Area-code)+(phone Number)
Does your parents stay with you and/or are dependent on you?

YesNo
Would you like to add parents information to membership directory ?

YesNo
Parents Information >

Enter parents information
Fathers Full Name

First NameLast Name
Mothers Full Name

First NameLast Name
Father-in-law

First NameLast Name
Mother-in-law

First NameLast Name
Once you submit your details, we will contact you if we have any questions.

Thank you!
Membership charges based on your selection*
Payment is OPTIONAL at this time. Please pay amount due below, if you wish to pay now using Paypal

Note: You should receive an email with total anyways & JSGA Treasurer will send seperate pledge (paid or outstanding) in coming weeks as well.

Thank you for your support to JSGA.
Do you wish to pay online using PayPal. Disclaimer: We do not store any financial information and use secured transaction method.*

YesNo
Paypal charges small transaction fee, would you like to add to the fee?*

YesNo
Final Amount
Total Amount Due (Credit or Debit Card option will be visible on the PayPal login screen on the bottom)

prevnext( X )
USDFinal amount you will be charged
Pay with PayPal

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
Should be Empty:

New Member Form

Spouse Information >

Children/s Information >

Parents Information >