CCI Membership Form

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CCI Membership Form

Membership Form - Jan 01,2023 thru Dec 31st, 2023

Cultural Center of India

Attn : Sunil Patel

300 E Franklin St, Richmond, VA 23219

Tel # 804-536-2524 www.cciva.org

Send your check to Above address Or once you submit this form you will see link to make payment online

Email *

CULTURAL CENTER OF INDIA

Single : $125

Option 1

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Family (2 Adults) : $ 250.00

Option 1

Option 2

Family (2 Adults & 1 Kid) : $300

Option 1

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Family (2 Adults &2 and more Kids) $325

Option 1

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Parent each person on top of membership (age under 75) $50

Option 1

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Additional Adult above 18 : $50

Option 1

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Last Name:
*

First Name:
*

Spouse’s Name:
*

Address: (with City , Sate and Zip code )
*

Tel No OR Cell No
*

Names of Unmarried Children DOB ( Optional ): Month/Year

Names of Retired Parents ( Living Under same Household& 75+ Age) - Free

Please Make Check Payable To: Cultural Center of India Ref/Memo: 2023 Membership Dues

Mail To: Attn : Sunil Patel

Cultural Center of India

300 E Franklin Street, Richmond VA 23219

For Office Use Only:Check /Cash:$_____250___#_____3260___8__Date:_6_/__203/___Recd By:_____NP_____

Note: Membership Due is July 1, 2023 & All membership is NON transferable

For member benefits, please visit www.cciva.org

Method of Payment *

Pay Online ( once you submit this FORM you will see a link to make ONLINE Payment )

CASH /CHECK

Add total $$ from your selections &

SUBMIT THIS FORM AND GET LINK TO PAY ONLINE

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