Registration Form

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Or Please print this page, fill it out, and mail it with a check
or

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Advance Registration is required
so that we can adequately plan for food and facilities.

The following persons are specifically invited: 

  • The spiritual head of the institution (or delegate).
  •  Current and former presidents, Board members, founders
  • Education Director/Interfaith/PR /Committee members
  •  Female member/representative/coordinator from the organization
  • Youth coordinators – and young generation (16 to 30 year old) members

Last Name: ________________________________________________________________________

First Name: _______________________________________________________

Street Address: ___________________________________________________

CCity  _________________________State___________ Zip code ____________

Phone no.  _______________________    Cell phone:_____________________

  Email: _______________________________________________


Signature: _________________________________  Date: ________________

Institution you are affiliated with: __________________________________________

YTitle/function in the Institution:_____________________________________________

   Registration before November 20:      $100.     Students $25 
                                     Nov 21 to Dec 10:       $125.        Students $35  
                         Dec 11 to Dec 15/on-site:       $150.         Students $50

             Kindly enclose a check (tax-deductible) payable to Hindu Collective Initiative 
and mail this form with the check to: 
Dr. Ved P. Chaudhary
22 Jackie Drive, Morganville, NJ, 07751

Ved@hcina.org     732 972 1489

Credit Card # _____________________  Expiration date __________________

CCard type (circle):     VISA   MC            3 digit code (on the back of card) _______

YSignature _______________________________ Date ___________________

Register On Line