The Association of Indians in America (AIA), Inc.
(A non-profit organization of Asian Indians founded in 1967)
Metropolitan Washington D.C. Chapter
Membership Form

Name: Dr/Mr/Mrs./Ms:(Last)_________________________(First)____________________(MI)__

Spouse:_____________________________________________________________________________________

Children:(First name & Date of Birth)
_________________________________________________________________________________________

_________________________________________________________________________________________

Occupation (optional):
(Self)___________________________(Spouse)__________________________

Street Address:_______________________________________________________________________

City:________________________________________State:________________Zipcode:_____________

Phone: Home: (_____)______-__________Office:(_____)______-__________

Email Address:_____________________________________________________________

Enclosed is my check for $___________for my membership in the Association of Indians in America.

Annual Family Membership (Dues $35) for year 200__.

Life Membership (Dues $300)

Additional Contribution $_____________.

Please make check(s) payable to The Association of Indians in America, Inc., and mail to:

The Association of Indians in America, Inc.
Washington DC Chapter
c/o Dr. Gajendra Shroff, Treasurer, AIA
6 Stonecutter Court
Gaithersburg, MD 20878

CONTRIBUTIONS TO AIA ARE TAX DEDUCTIBLE