Bengali Association
  of
  Minnesota
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Membership Form

Fields with * sign are required
Last Name    * First Name    *
Spouse’s Last Name   Spouse’s First Name  
Names and Ages of Children: 
Name   Age  
1.
2.
3.
4.
Address    [ Street Number ]
 [ City ]
 [ State ]
 [ Zip ]
Telephone 
Email
Can we contact you at this email address? Yes No
Can we send our newsletter or any other information to your home address? Yes No

The information provided by you is for official use by the Bengali Association of MN. The information will not be shared or distributed for any other purpose.


Note: Please complete this form and mail a check for $25 to
Bengali Association of MN
c/o Kalyan Mustaphi
5444 Orchard Ave N
Crystal. MN 55429
Ph- 763-537-8291

© 2004 Bengali Association of Minnesota. All rights reserved. For more information contact: MNBangali