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Membership Form-Main_Form 2025

KERALA ASSOCIATION OF DALLAS, INC

3821 Broadway Blvd, Garland TX 75043

Phone: 972 271 2222

MEMBERSHIP APPLICATION FORM

Membership Status

Single-$20.00 | Family-$25.00

Membership ID

Applicant Information

First Name

Last Name

Spouse’s First Name

Home Phone #

Mobile Phone#

Would you like to receive Calls/Text/SMS/Whatsapp/ updates for KAD Events? Carrier Rates may apply.

Yes

Home Town in Kerala

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Children’s Information

Click the + for additional entries.

Repeater Field

Child’s Name	Select Gender	Select Grade Level

Would you like to receive Kairali via email?

Yes

Membership Reference

Referers/Event Name

Payment Method

Please scan this QR code with your Bank App.
or
Send the payment to 972 271 2222.

Zelle Name if different from official name.

Please mail your check to 3821 Broadway Blvd, Garland TX 75043.

Check # if available.

E-Signature

Please enter your full name in lieu for your signature. Thank you.

Signature of Applicant

Month

Year

MEMBERSHIP APPLICATION FORM

Applicant Information

Children’s Information

Please mail your check to 3821 Broadway Blvd, Garland TX 75043.

E-Signature

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