Applicant Information * New Member Id Date of Renewal
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Member's First Name* Middle Name
Last Name * Membership Type* Individual Membership
Family Membership
Spouse Name Last Name
Street No * Address*
Country
City*
State* Zip Code*
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Email* Email 2

Membership Categories & Payment Details
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General Member-Individual(Due jan1/Apr 1 every year) $150
Life Member(LM) $3000
Extra Donation Any Amount
Total
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I pledge that I will cause no harm to HDBS, to its reputation or the reputation of its employees, members and volunteers. I will abide by the rules and regulations of HDBS as set out in its Constitution and Bylaws and policy documents. If I am found to be in any violation, my membership can be denied, suspended or revoked. I understand that if I am a General Member (GM) and I default to pay my dues on time, I will become a donor (GD) and lose all privileges including but not limited to voting rights normally enjoyed by a GM.
I hereby declare that the above information is correct to the best of my knowledge. I shall notify HDBS in writing, if there is any change to the above information within one month of the change.
I authorize HDBS to communicate with me by e-mail, sms or social media and share my contact information in HDBS magazine(s) or on the HDBS website.
I understand that my visit to Durga Bari will be at my own risk and I will hold HDBS or its volunteers harmless from any liability and loss.
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