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INDIAN AMERICAN KERALA CULTURAL AND CIVIC CENTER
(THE KERALA CENTER)

Non-proft Tax-exempt organization
18 24 Fair fax Street , Elmont, New York, 11003
Tele- 516-358-2000
MEMBERSHIP APPLICATION


Name________________________________________________________________

Age (optional)___________

Address:
Street_________________________________________________________________

City______________________State_____________ Zip____________

Telephone Home___________________________ Work___________________________

Occupation____________________________________________________

Citizen of (check one) ( ) India ( ) United State

Marital Status (check one) ( ) Married ( ) Single

Name of Spouse ___________________________________________

Occupation ___________________

Number of Children : Boys _____________ Girls _____________________

Name of the Children’s _____________________________________________
_____________________________________________
______________________________________________


I, ______________________________________________ hereby pledge to contribute the following to the Indian American Kerala Cultural and Civic Center (The Kerala Center) as per the terms set forth. I understand that if I fail to meet the payment schedule then I relinquish my membership rights and privileges, and I will automatically moved to the donor category.



( )Grand Patron $25,000.00 ( Yearly $5000.00 ,within five year period)
( )Patron $10,000.00 ( Yearly $2000.00,within five year period )
( )Benefactor $5,000.00 ( Yearly $500.00, within ten year period )
( )Regular Member $3,000.00/1500.00 ( Yearly $150.00,within 20 year period/ one time payment )
( )Associate Member $500.00 ( One payment, no voting privileges )
( )Association Member $____________ (One payment, one delegate to the Board and General body )
( )Donor $____________


Signature & Date


MEMBERSHIP PAYMENTS AND SCHEDULES

GRAND PATRON:
Any individual contributing a sum of $25,000.00. The first payment shall be $5000.00 and the rest shall be paid every year on or before November 1st within a period of four year. Each Grand Patron is eligible to cast two votes. The names of both spouses will be inscribed and the photographs of both spouses will be displayed in the Center.

PATRON:
Any individual contributing a sum of $10,000.00. The first payment shall be $2000.00 and the rest shall be paid every year on or before November 1st within a period of four years. Each Patron is eligible to cast two votes. The photographs of both spouses will be displayed in the Center.

BENEFACTOR:
Any individual contributing a sum of $5,000.00. The first payment shall be $ 500.00 and the rest shall be paid every year on or before November 1st within a period of nine years. Each Benefactor is eligible to cast one vote. The photo of both spouses will be displayed in the Center.

REGULAR MEMBER:
Any individual contributing a sum of $3000/$1500.00. The first payment shall be 150.00 and the rest shall be paid every year on or before November 1st within a period of 19 years OR a sum of $1500.00 in one time payment. Each regular member is eligible to cast one vote.

ASSOCIATE MEMBER:
Any individual contributing a sum of $500.00. Payment is to be made in full at the time of application for membership. Associate Members do not have the right to vote in the Center.

DONOR:
Any individual contributing any amount. Donors do not have the right to vote in the Center.

*On a contribution of $100,000.00 or $50,000.00 the Auditorium or Conference Room, respectively, will be named in honor of the contributor, or beloved one. This will be done on a first come, first served basis.