Assam Foundation of North America
(AFNA)

A Non-Profit, Charitable Organization with the sole purpose of helping charitable causes in Assam, India and North America

Membership Form

    YES, I like to join AFNA to help the charitable causes in Assam.
    YES, I would be able to help in AFNA activities.

Name:   			.............................................................................
Spouse’s name: 		.............................................................................
Address: 			.............................................................................
				.............................................................................
				.............................................................................
Telephone number:		.............................................................................
Email address:			.............................................................................

(Please provide your email address. The saving from a postage stamp can buy needed supplies for a school in Assam.)

Membership dues:	$ 25.00 (Family), $ 15.00 (Single),  $ 5.00 Student)		...........
			Additional contribution to AFNA’s general fund		...........
Total (Please make checks payable to AFNA)		...........

Project Suggestions:		.............................................................................
.............................................................................

Other Suggestions:		.............................................................................
.............................................................................

Please mail to:		Krishanu Kaushik		Istakur Rahman
President, AFNA			Secretary/Treasurer
			44963 Lemont  Rd.   		3160 Cedar Crest Drive
Canton, MI 48187		Troy, MI 48083
Email address:	 assam_afna@yahoo.com	

 No, I do not want to become a member of AFNA for the following reasons (we would like to get your feedback):
			
Name (Optional):

AFNA is a non-profit organization. All contributions to AFNA are tax deductible. It is a 501(C)(3) organization. Members may obtain information regarding tax ID and a copy of the current financial statement by sending an email to Assam_afna@yahoo.com