BSCFL - Membership Information Form

MEMBERSHIP INFORMATION FORM

Applicant Name:*
Email:*
Birth Year:	Age: 0 Yrs
Gender:
Home Phone:	() - -
Cell Phone:	() - -
Address:*
City:*
State:
Zip Code:*	5 digit zipcode
Upload photo:	You can upload your recent photo, passport size (2" x 2"), in one of these file formats: JPG, PNG, GIF. Maximum file size allowed is 50kb. If you do not have any photo editor on your computer, you can use free websites like http://pixlr.com/

	For security reasons, enter the text you see in the above graphic:

IMPORTANT NOTE:	By 12/31/2017, all the 2018 paid members’ photo ID must be uploaded on the web site, and 2018’s photo ID must be picked up by 06/30/2018. Delay in the above will result in $25.00 penalty per member.


	NAVRATRI 2018 DAY 3 Friday, October 19, 2018 BARTOW CIVIC CENTER
	NAVRATRI 2018 DAY 4 Saturday, October 20, 2018 BARTOW CIVIC CENTER
	NAVRATRI 2018 DAY 5 Friday, October 26, 2018 BARTOW CIVIC CENTER

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