Kerala Association of Los Angeles
		   A Non-Profit Organization
			P.O. Box 4761
		  Chatsworth, CA  91313-4761
		 Website:  www.a2all.com/kala

APPLICATION FOR MEMBERSHIP

NAME: ________________________________________________________________
					          wife's name
ADDRESS: _____________________________________________________________

	 _____________________________________________________________

TELEPHONE:  _____________________________________________

E-MAIL ADDRESS:  ______________________________________

NAMES & AGES OF CHILDREN (OPTIONAL):

________________________________________________	____________

________________________________________________	____________

________________________________________________	____________

________________________________________________	____________

HOME TOWN IN INDIA (OPTIONAL):_________________________
MEMBERSHIP FEE:	FAMILY ($20.00) ________________
			SINGLE  ($10.00) __________________
Please make checks payable to Kerala Association of Los Angeles

Please enroll me as a member of the Kerala Association of Los 
Angeles (KALA),  a non-profit organization.  Herewith, I am 
enclosing an amount of $________for the annual membership for
year___________



Date:_______________	SIGNATURE: ________________________________