MEIA Membership Registration Form

MELBOURNE EAST INDIAN ASSOCIATION INCORPORATED
Membership Application Form

(Please Submit One Form for each Member and Partner Application)
Name

First NameLast Name
Date of Birth:

MonthDayYear
Gender
Address:

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number:

Area CodePhone Number
E-mail
example@example.com
Spouse / Partner Name

First NameLast Name
Dependant Children (Optional)
Are you of East Indian Origin
If YES, indicate which village in Maharastra / Thane / Raigad (If known)
Optional Information
Profession
Interests (Music / Dance / Drama / Language)
Sports
Membership Rules
1. Membership is available to anyone 18 years of age or older. 2. You promise NOT to use to conduct any fraudulent or business activity or have more than one Member Account at any time.
MEIA RULES
Accepting the MEIA Rules of Membership
* Melbourne East Indian Association of Victoria reserves the right to accept or reject any application for membership as outlined in the Association Rules
Membership Fees
Currently all MEIA Membership fees have been waived till futher notice.
Privacy Policy
All details in this Membership Form will be held in confidence in the records of the MEIA only.
Accepting the MEIA Privacy Policy
Once you submit your application, we will contact you shortly to confirm your membership application. Thank you!
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MELBOURNE EAST INDIAN ASSOCIATION INCORPORATED