style='font-family:Broadway;color:blue'>CHINMAYA MISSION
w:st="on">CHICAGO
w:st="on">NW
style='font-family:Broadway;color:blue'> INDIANA
REGIONAL CENTER
style='font-family:Broadway;color:blue'>
style='font-size:10.0pt;font-family:"Arial Rounded MT Bold"'>At IACC,
w:st="on">8605 MERRILLVILLE ROAD,
w:st="on">MERRILLVILLE - IN 46410
style='font-family:"Arial Rounded MT Bold"'>Sundays 4:30pm – 6:30pm from Sept 17th
‘06 – June 10th ‘07
style='font-family:"Arial Rounded MT Bold";color:blue'>2006 – 2007 REGISTRATION
FORM
Family Name:______________________________
Home Phone:_______________
Mother’s name:_______________________Father’s
name:___________________
Cell phone #(s):_______________________ _________________________________
Mailing address:______________________
_________________________________
City:___________________________State:__________________Zip:_____________
Parents e-mail: (1)____________________________(2)_______________________
Child’s name
style='mso-spacerun:yes'> Birthdate
style='mso-spacerun:yes'> School grade enrolled in
style='mso-spacerun:yes'> (mm/dd/yy)
style='mso-spacerun:yes'>
style='mso-spacerun:yes'> 2006/2007
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please
enroll my son/daughter in Bala Vihar/Yuvakendra program starting on
Month="9" Day="17" Year="2000" w:st="on">September 17th 2006/June
10th 2007.
style='font-family:"Arial Rounded MT Bold"'>Enroll following in the Adult
discussion group:
style='font-family:"Arial Rounded MT Bold"'>Both parents:_________
Father only:__________Mother only:____________
style='font-family:"Arial Rounded MT Bold"'>
style='mso-spacerun:yes'>
style='font-family:"Arial Rounded MT Bold";color:blue'>A donation of $75/per
person/ maximum of $150/ per family for the school year 2006/2007 should be
enclosed with this completed form.
style='font-family:"Arial Rounded MT Bold";color:blue'>Please make check
payable to Chinmaya Mission NW Indiana.
style='font-family:"Arial Rounded MT Bold"'>
style='font-family:"Arial Rounded MT Bold"'>
For office use only
Date:_____________paid by
check #________ / Cash:_______Amount:________
For further
information contact
style='font-family:"Arial Rounded MT Bold"'>Padmini Makam at 322 -7268/ cell
808 3431/padminimakam@comcast.net
style='font-family:"Arial Rounded MT Bold"'>Suchita Shah at 924 - 8268/ cell 614
1106/suchita @suchitashah.com
style='mso-spacerun:yes'>
style='font-family:"Arial Rounded MT Bold";color:maroon'>
style='text-decoration:none'>
style='font-family:"Arial Rounded MT Bold";color:red'>Mail the completed form
along with your check to
style='font-family:"Arial Rounded MT Bold";color:red'>Suchita Shah,
w:st="on">10411 Victoria Ct,
w:st="on">Munster, IN
w:st="on">46321
style='font-family:"Arial Rounded MT Bold";color:red'>Dhanyavaad
