Registration form -

Please read guidelines and rules before filling the form. When you submit your information, it will direct you to secure payment options.

Membership	9/2010 - 6/2011
Single	$275
Family	$400
Sanskritam Class	$75/Child

Family Registration form September 2010 – June 2011

	First Name	Last Name	E-mail	Volunteer sign-up
Mr.
Mrs.

Address:	City:
State:	Zip:
Home Phone: (XXX) XXX-XXXX	Mobile:

Magazine subscription: Choose one
Balavihar (through Grade 7)
Udghosh (Grade 8+)
Tapovan Prasad (Adults)

Bala Vihar Student Information:

First Name	Last Name	Grade	Date of Birth	Samskritam class (Grade 5 and up)

Please initial that you have read the notes regarding the Facility Use and agree to comply with it.

If you are registering for the first time, please give us name of the person whom we can thank for the referral. If you have found out about CMP through other means(websearch, posters, etc) please enter that information here:

Add subscription to Mananam series: $16 for one year or $300 for lifetime subscription

Waiver and Release

In consideration of your acceptance of my family’s participation in the above program, I hereby, for myself and my family, waive and release Chinmaya Mission and their officers, trustees, volunteers and members, and all other persons participating in the program, or involved in planning or execution of the program, from all liability or claims arising from any injury to myself, my child or my property. This release shall include, without limitation, all claims for negligence, and shall exclude only claims for willful injury, which exclusion for willful shall extend only to the person committing willful injury and not to any other person released hereby. I hereby give permission for my family to have their picture taken while participating in activities associated with Chinmaya Mission. Said pictures become the sole property of Chinmaya Mission and will be used only for recruiting/information-sharing purposes.

Signature (type your name here):

Chinmaya Mission is a non-profit organization and our Tax ID# is 51-0175323. Please make checks payable to Chinmaya Mission Portland. Please check with your employer if they make matching grants to non-profit organization. 50% of your registration fee is tax deductible.