Gujarati Association of Western Mass

67 Monroe Street
Chicopee, MA 01020

MEMBERSHIP FORM
Primary Member: ________________________________
(Last name, First name, Middle Initial.)

Spouse Name: _______________________________

More Questions? Please call Sheetal Patel at 413-519-3133 or

e-mail: gawm12@gmail.com.
Please visit www.gawmonline.org
 Gujarati Association of Western Mass
67 Monroe Street
Chicopee, MA 01020

Membership Fee of $250 per Family, per year.

Includes Member, spouse, unmarried children and 2 elderly parents ALL LIVING AT
THE SAME ADDRESS.
Please add extra $100 per person staying at the same address
Additional married family members require a separate membership.

More Questions? Please call Sheetal Patel at 413-519-3133 or

e-mail: gawm12@gmail.com.
Please visit www.gawmonline.org
 Gujarati Association of Western Mass
67 Monroe Street
Chicopee, MA 01020
Un-Married Children: 2 Elderly Parents living at
Name Gender Birth date the same address
Name
Relationship Age

More Questions? Please call Sheetal Patel at 413-519-3133 or

e-mail: gawm12@gmail.com.
Please visit www.gawmonline.org
 Gujarati Association of Western Massachusetts
106 Capital Drive
West Springfield, MA 01089

Extra Person Living at the same address (Please include $100 per person in the check)
FamilyMembership Extra Persons/Service Total Amount

250

Member Mailing Address: ________________________________________________

Telephone: Home:_________________ Cell:__________________

Fax: _________________ Email:___________________

Please make checks payable to:

Gujarati Association of Western Mass

Mail to: GAWM, 67 Monroe Street, Chicopee, MA 01020

More Questions? Please call Sheetal Patel at 413-519-3133 or

e-mail: gawm12@gmail.com.
Please visit www.gawmonline.org