MIIACA  Member's  Registration

Click here if you would like to print the form: ViewForm

Instructions for online form:

1. Enter all the information correctly and print the form.
2. Mail the form along with registration fee payable to 'Indian American Cultural Association (IACA)' at the following address;
Bharat Malhotra 48197 Manhattan Circle Canton, MI  48188

Registration fee
$125 per family

NOTE: The fields marked with * are required.

Last Name:*
First Name:*
Spouse Name:*
Street/Apt.:*
City/State/Zip:*
Home Phone:*
Cell Phone:
Email:*
Any other email:
Kid'sName/DOB:
Kid'sName/DOB:
Kid'sName/DOB:

 

Hobbies: Please encircle at-least one of the following.

Music, Singing, Dancing, Acting, Comedy, Stage Mgmt, News Letter, Sports, Outdoor Activity, Other (specify please).

 

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