CCIVA Membership Form 2021

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CULTURAL CENTER OF INDIA, VA
6641 Ironbridge Parkway, Chester VA 23231 | 804.536.2524 | info@cciva.org

CCIVA is a leading non-profit organization that carves and hosts numerous unique programs to serve the community in Central Virginia, bringing everyone together under one roof to share our culture & roots.
Membership allows you and your family to take advantage of many unique events we bring to the community!
For a calendar of events, volunteering opportunities, and more please visit the official website www.cciva.org
The form must be completed and fees must be paid to sign up for the calendar year Jan 1st to Dec 31st 2021.

Family membership: $50 annual fee - Family with unmarried kids and retired grandparents of 70 yrs & above living in one household included.
Single: $25 annual fee for a single person.

Email Address *

Spouse's Email Address

Membership Options *

Family: $50.00

Single: $25.00

First and Last Name *

Spouse's Name

Street Address *

City, State & Zip Code *

Phone Number *

Names of Family Members Along With Their Ages (as of January 2021)

Payment is due when form is filled *

*Pay Online via Paypal at https://www.paypal.com/cgi-bin/webscr under Membership Payment

*Check payable to Cultural Center of India. Memo: 2021 Membership Dues. Mail it to: C/O Shamin Hotels, 2000 Ware Bottom Spring Rd, Chester VA 23836

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