First Name* Last Name* Preferred Mobile Number* Ok to receive SMS YesNo Secondary Telephone Number Email* Address Line* City* State* Country* Employer Do you want to enroll your spouse/partner as a member? NoYes [group inline addspouse] (only if you answered Yes above) First Name Last name Preferred Mobile Number Secondary Telephone Number Email Employer [/group] Number of Kids (0 - 4 yrs) 012345678910 Number of Youth (5 - 17 yrs) 012345678910 Annual Membership (Parents/Guests) 012345678910 Durga Puja (Parents/Guests) 012345678910 Kali Puja (Parents/Guests) 012345678910 Sarawati Puja (Parents/Guests) 012345678910 Membership fees (this will all be the options under the default Adult membership. For Family – Husband, Wife and kids below 4yrs is $300), Adult (18+) - $150, Youth (5-17) - $75, Kid (0-4) - Free, Parents/Guests – Durga Puja - $60 / Kali Puja - $25 / Sarawati Puja - $15. If parents are being added for the full year, it should follow the same pricing as Adults ($150). Have you ever been a member of Bay Area Prabasi in the past? YesNo If you have answered yes please provide your membership number Total Amount: [calculator total Precision:2 "(Enroll-Member-value+(75*Youth)+(150*Annual_Membership)+(60*Durga_Puja)+(25*Kali_Puja)+(15*Sarawati_Puja))"] I have reviewed the Code of conduct document and should my application be successful, I understand that as a member I must adhere to the code of conduct or will be subject to removal. I have read and agree to the Terms Of Service
