Membership Application Form

Applicant

First Name: _______________________________________

Last Name: _______________________________________

Address: _______________________________________

City: _______________________________________

State: ________________ Zip: ___________________

AnnualMembership

Please Select One:

Family: $25.00

Individual: $20.00

Student: $10.00

Contact Info

EMail: ___________________________________

Mobile Number: ___________________________________

Home Number: ___________________________________

Donate

“ Wea l th never decreases because o f char i t y ”

Please donate generously as we are seeking of your financial support to execute association

programs for honorable community.

Donation Amount: $________

Family Members

Spouse First Name: ________________________ Spouse Last Name: _________________________

First Name: ________________________ Last Name: _______________________ Age: ___________

First Name: ________________________ Last Name: _______________________ Age: ___________

Please Make Your Check Payable To “Pakistan Association Of New York Capital District” And Mail To Mr. Laeeuqe Khan. Address: 8 Field Stone Drive Clifton Park, New York 12065.

Phone518 - 966 - 2PAK (2725)

EmailInfo@PakNYCap.org

Websitewww.PakNYCap.org

P a k i s t a nZ i n d a b a d