DASTAK Membership Form

MEMBERSHIP APPLICATIONS

Please Print Clearly and Legibly

Make Checks Payable to

DASTAK - NETWORK OF PAKISTANI PROFESSIONALS

67 Joni Avenue

Hamilton, NJ 08690

NAME:__________________________________________________________________________________________________

ADDRESS:_________________________________________________________________________________________________

____________________________________________________________________________________________________________

CITY:_____________________________________ STATE: _____________________ ZIP: ___________________

E-MAIL:_______________________________ HOME PHONE:____________________________________

WORK PHONE:__________________________________________ FAX:_____________________________________________

OCCUPATION: ______________________________________ COMPANY:___________________________________________

SCHOOLS ATTENDED/DEGREES/MAJORS:_________________________________________________________

All Memberships expire on December 31st 2002 unless otherwise stated.

1) NEW MEMBER ($50)___________ (exp. 12/31/2002)

2) TWO YEAR REGULAR ($100)___________ (exp. 12/31/2003)

3) GRADUATE STUDENT ($25), please provide photocopy of valid school id_________(exp. 12/31/2002)

4) MAIL LIST ONLY___________

5) IS THE ABOVE ADDRESS AN UPDATE? YES____ NO____

6) VOLUNTEER FOR A COMMITTEE (MEMBERS ONLY, Please mark your choices):

___ NETWORKING EVENTS ___ INTERNET

___ PROFESSIONAL DEVELOPMENT ___ CORPORATE RELATIONS

___ NEWSLETTER ___ MEMBERSHIP

___ COMMUNITY RELATIONS ___ OTHER (Please Specify): _______________________________________

7) HOW DID YOUR HEAR ABOUT DASTAK? _____________________________________________________________________________________

Download The Application: DASTAKAPPL.doc

___	NETWORKING EVENTS	___	INTERNET
___	PROFESSIONAL DEVELOPMENT	___	CORPORATE RELATIONS
___	NEWSLETTER	___	MEMBERSHIP
___	COMMUNITY RELATIONS	___	OTHER (Please Specify): _______________________________________