Membership Package Registration – USA Please enable JavaScript in your browser to complete this form. – Step 1 of 2Reference Check *Kutumba Existing Member ReferenceNo existing reference, send email to committee with details and registerAlready sent email/talked with committee memberAs per the Kutumba security new guidelines , reference check is mandatory process. *Accuracy of the below data is key thing for Kutumba registration. Kutumba existing member name *FirstLastKutumba existing member email **After registration, reference confirmation email will be sent to this email. Kutumba existing member phone*After registration, Membership committee may reach out here for any reference check *Reference should be only from USA and Canada numbersEmail to Kutumba Committee *Content of this will sent to Kutumba Committee , please send the information of 1.How did you know about Kutumba ? 2. Introduction about your home town and your work/study info if you are student? 3. Why you want to join Kutumba?Information about connect with Kutumba Committee over email/phone *Information of Kutumba communication 1. Provide the date when the email was sent to [email protected] (if applicable only)? 2. Provide the committee person info you connected over phone ?NextName *FirstLastPhone **Phone no should be only from USA and Canada numbersEmail *Please use the email which was used in previous yearCity *CityFamily Name *Example : Saralaya, Mattu,Ancestral Home town/Native place *Example : DharmasthalaSpouse Name (If you are single, please say NA) *Spouse Phone Number(If applicable)(Optional – its required if they want to be part of Whats App group) *Phone no should be only from USA and Canada numbersSpouse Email (Needed for Election)Select State *AlabamaAlaskaArizonaArkansasNorth CaliforniaSouth CaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingMembership Id/Phone No (If you have taken before)Previous membership no/Phone no if applicable only *In case of Phone no, Please use only USA and Canada numbersWhat is the communication preferred to contact you? *EmailWhatsAppBothIf not sure, please send email [email protected]What you are looking from Shivalli Kutumba North America Association?Preserve Cultural & Religious ValuesPlatform to connect and NetworkMatrimonial forumVolunteering and Charity workKids Educational forumLearn Tulu/Kannada LanguageOthersPayment ModePaypal(via Credit/Debit Card ,Bank Account)Check(Send to Shivalli Kutumba, 1911 Hartshorn Ave, Troy, Michigan , 48083)Zelle Transfer Zelle Email ID : [email protected] | check favoring “Shivalli Kutumba of North America”Membership Type and Fees10 Years Term – Grand Patron – $1,000.0010 Years Term – Patron – $500.0010 Years Term – Family – $225.00*10 Years Term – Single – $90.00*Annual – Student – $5.00*Annual – Single – $10.00Annual – Family – $25.00 * Single/Student – If you are married, please do not choose this optionMembership Type and Fees*10 Years Term – Grand Patron – $1,020.8010 Years Term – Patron – $510.6510 Years Term – Family – $230.10*10 Years Term – Single – $92.33*Annual – Student – $5.60*Annual – Single – $10.70Annual – Family – $26.02* PayPal fees extra * Single/Student – If you are married, please do not choose this option)Bank Name *Ex: ChasePostal service provider and posted dateEx : USPS/12th May 2022Zelle Transaction ID *Zelle Date of Transfer *Ex : 12th May 2022Misc NotesKutumba ByLaws I confirm that I have read and shall agree to the Shivalli Kutumba Bylaws and code of conduct (Please refer https://shivallikutumbana.org/constitution/)Kutumba constitution linkSubmit
