Membership Registration

stltelugu@gmail.com

Primary Member Information

Select Membership * Email Address * Enter OTP Primary Phone Number * First Name * Last Name * Street Address * Apartment, suite, etc City State/Province ZIP / Postal Code Country Membership Type:

Family $125

Grandparent $50

Student $25

Individual $60

Lifetime $1,500

Spouse Information

Spouse Last Name (Enter NA when Not Applicable) * Spouse Middle Initial Spouse First Name (Enter NA when Not Applicable) * Spouse Email Address (Enter NA when Not Applicable) * Spouse Phone Number (Enter NA when Not Applicable) *

Children Information

Kids Name (as it appears on a Valid Photo ID) - 1 Date of Birth - 1 Kids Name (as it appears on a Valid Photo ID) - 2 Date of Birth - 2 Kids Name (as it appears on a Valid Photo ID) - 3 Date of Birth - 3

Consent *
I hereby certify that all the information provided above is correct to best of my knowledge and I give my consent to Telugu Association of St. Louis (TAS) to use the above information (member name, address and phone number only) to publish the TAS Directory/Souvenir and communicate as needed (Default is Yes)

Yes No

Payment Method *

Zelle

PayPal