Hindu Temple Society of Mississippi

*User Name:**
*Password:**
*Confirm Password :**
*First Name:**
*Last Name:**
*Gothram:**
*Nakshatram:**
*Sex:**	Male Female
*Date of Birth:**
Anniversary Date:
Residence Address
*Address1:**
Address2:
*City:**
*State:**
*Zip:**
Mailing Address
*Address1:**
Address2:
*City:**
*State:**
*Zip:**
*Phone1 :**
Phone2 :
Home :
Fax :
*E-mail Address:**
Pledge:
Other information:
Describe briefly your contributions to HTSM activities:
(All Hindus by birth or by choice are eligible for membership in HTSM.)
*Type of Membership Applied for:**
Life	Dues $ 2,500 in one payment or $ 3000 in three equal payments in three years.
Regular	Dues: $150 per year
Payment
Amount:
Check:
Both Life and Regular Members can participate in the voting process of the election of Board of Trustees. Members in good standing are eligible to contest for the Trustee positions.
Sponsored by
Address:
Phone:
FAX: