Membership Registration Form 2011-12


Chinmaya Mission Washington Regional Center - Chinmaya Somnath





NOTE: Please don't forget to submit the form at the end of the page and mail the confirmation page along with pledge check.
 Are you currently a Chinmaya Mission member?   
 If Yes, please select the chapter you currently attend:
Please Choose Session Preference below:
 1st Preference:
 2nd Preference:
 Please provide your contact information below: 
 Primary Email Address:  
 Address:        
 City:     
 State:    
 Zip Code:  
 Home Telephone #: (e.g.7037291234, No "-", "(", ")") 
 Professions(Optional):
Adult Information
First
Name 		Last
Name 		M/F Cell Secondary
Email Address 		Language
1
2
Child Information
First
Name 		Last
Name 		M/F DOB
(mm/dd/yyyy) 		Grade
(on 9/30/2011) 		Language Shloka
1
2
3
4

Please note the Annual Pledge levels: Click here for Instructions
  a. Sponsor Level:

        • $1212/year OR $101/month (minimum 12 months) - this includes Bala Vihar, Language classes, Shloka classes and 1-yr subscription to the Bala Vihar magazine. You would still need to register for all classes you wish to attend, and keep regular attendance throughout the year.

  b. Basic Plus Bala Vihar:

        • Basic Annual pledge per family = $360.
        • Bala Vihar Annual pledge = $240(1 child) / $420(2 or more children).
        • Languages Annual pledge = $100 for first member, and $50 for each additional member of the family.
        • Shloka Annual pledge = $50 for each child.

Pledge Type       Sponsor Level   Basic Plus Bala Vihar
Pledge Amount
Basic Pledge:$    
Bala Vihar Pledge:$    
Language/Shloka Pledge:$    
Total:$    
Would you be interested in volunteering?
Teaching Bala Vihar Teaching a Language
Teaching Music Facilities
Administration Cultural
Library Annapurna
Registration Website Updates
   Check here if you have custody issues with the children you are enrolling. CM will request application to be signed by both parents/guardian before processing the request.
   Check here if all email addresses should be used for general announcements. By default only primary email address will be used for general announcements.
  I have carefully read the Instructions, and agree to abide by them in entirety.


Please print and complete the receipt as per the registration instructions.
Make Check Payable to: "CMWRC"
Mail payment information to:
Attn: Suhashini Muthukrishnan (Membership Co-ordinator),
25462 Chambers Drive, South Riding, VA 20152

OR
Attn: Murali Kadaveru (Membership Co-ordinator),
3786 Avenel Ct, Fairfax VA 22033

For questions or inquiries, please email membership@chinmayasomnath.org

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