Brahmin Samaj of Georgia, Inc.
 (A registered 501 (c)(3) Tax Exempt Organization)  EIN # 582180725
 P.O. Box 80162
 Atlanta, GA  30366
 Tel/Fax: 770-662-8628
 E-mail:  BSOGATLANTA@HOTMAIL.COM
Website:  https://members.tripod.com/~Brahmin_Samaj_of_GA/
5TH ANNUAL ALL BRAHMIN CONVENTION - 2003
MATRIMONIAL INTRODUCTION REGISTRATION FORM

Mail completed for before May 31, 2003 to:  BSOGA, 1380 Cornerstone Place, Tucker, GA  30084, USA - Please include one (1) passport size Photo
Name:
          

 Date of Birth:
 Occupation:
Address:
City:

  
 State:
 Zip:
 Country:
Phone: (H)


 Phone: (W)
 Fax:  
Cell:
Legal Status:


 E-Mail Address:
Legal Status (U.S. Citizen, Green card Holder, H1-B, Student, Visitor, Canadian Citizen, etc.)
Height:

 Weight:
 Gotra:  
Native Place:
Name of Parents:
   
Brothers & Sisters:
Education:
 
 Name of Institution:
Marital Status:

 Profession/Occupation:
Something About Me:
Few Things about Soul mate:
PLEASE PRINT:  ALL INFORMATION IS REQUIRED TO PROCESS REGISTRATION.    Please make check Payable to BSOGA, Inc.

To accommodate maximum delegates we are doing all that is possible to cut the cost and still strive for best quality services.  Your donation to BSOGA, Inc. is Tax Deductible.

REGISTRATION FEE(S):
(1)    $80.00 PER PERSON RECEIVED POST MARKED BY MAY 31, 2003.
(2)    $100.00 PER PERSON FOR REGISTRATION AND PAYMENT RECEIVED AFTER MAY 31, 2003
        Registration includes one Directory, participation in Matrimonial Intro. Convention activities, Breakfast, Lunch, Dinner.
(3)    $40.00 Per applicant to add information in booklet, but not attend convention.  Booklet will be mailed after convention.
(4)    $25.00 Per booklet to be mailed after convention.

      Lodging is to be paid by registrant directly.

I, the undersigned, have received, read, understood and hereby agree, acknowledge and accept all the rules-regulations and guidelines set forth for the Matrimonial Introduction/Convention participation.  I further agree to release, indemnify and hold BRAHMIN SAMAJ OF GEORGIA, Inc., its members and organizers harmless from any and all actions and liability, of any nature whatsoever, consequential or otherwise, resulting from or relating to this Matrimonial Intro./Convention.  I also understand that the organizers guarantee nothing and are not qualifying nor endorsing any candidate(s).  It will be the sole responsibility of the candidate to perform background checks.  BSOGA and the organizers are not liable for any potential outcome from this event.
Signature:
 Date:
Date Received:
 Check #  or Cash:
Total Amount:
 Total Attending:
Notes: