Please complete, print, and mail this form to the following address:

Gauranga Bose
9505 Windbeat Way
Columbia, MD 21046

 

Prantik 10821 Sandringham Road Cockeysville, MD 21030

Tax-Exempt, Non-profit Educational and Cultural Organization,  

Name : Spouse's Name : Child's Name(s) : (First names only) Address : City : State :   Zip Code :   Telephone :   - E-mail :

Membership Type :   Life Member ($175.00)  $20 per year(family)  $10 per year(Student)

Please make check payable to Prantik 

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Yes! I want to get actively involved. I want to write for:  Prantik Online  I want to organize:Cultural Programs Membership Drive Banga Sammelan Youth Activity Picnic Other

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Membership fee is tax-deductable

Make a Prantik membership gift to your friends and family