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)
Websitewww.PakNYCap.org
P a k i s t a nZ i n d a b a d