Membership Registration – Tharus and Friends Association

Name *

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Middle

Last

State/country *

Would you also like to contribute for Scholarship? *

Membership: *

Scholarship:

Year

If you are becoming a family member, please enter number of members in your family. *

Member-1 *

First

Last

Member-2 *

First

Last

Member-3 *

First

Last

Member-4 *

First

Last

Member-5 *

First

Last

Member-6 *

First

Last

Member-7 *

First

Last

Member- 8 *

First

Last

Member- 9 *

First

Last

Member- 10 *

First

Last

Note: Please make payment before submitting the Form by clicking the DONATE button below.