SRI GURU SINGH SABHA, Inc.

, 541 Prospect Street, Glen Rock, NJ 07452 Membership Form Membership Window (Dec 2, 2012 to Dec 31, 2012): Fridays (7:30 pm 10 pm); Sundays (9:30 am 3 pm) Monday Dec 31, 2012 (7:30 pm 10 pm)
Membership Renewal Number:_________________ PLEASE PRINT: Name:_____________________________________________________________ DOB: Month______ Year______ New Member Application Number:____________

Address:_________________________________________________________________ US Citizen: Yes____ No____ City:____________________________________________ Tel:____________________________ State:_________ Zip:__________

Email (Please Print): __________________________________________

Do you want your address included in our membership list at the SGSS Glen Rock website? Yes (Y)_______
1. 2. 3. 4.

No (N) _______ (If no, then we will include only your name and City).

I solemnly declare that I am over 18 years of age, I believe in One God, the ten Gurus from Sri Guru Nanak Dev ji to Sri Guru Gobind Singh ji, and accept Sri Guru Granth Sahib ji as my present Guru, and I do not follow any other religion. I have my primary residence in the State of New Jersey, or New York State Counties of Rockland, Orange, and Westchester. I am not a member of any other Gurdwara or Sikh religious organization and have demonstrated an intimate religious interest in SGSS, Inc. Glen Rock, by being a regular attendee at its weekly Diwans. If I run for an Office Bearer position of SGSS Glen Rock, I will show my proof of permanent residency (US Passport or Green Card) to Election Committee. Date: ______________________

Signature:_______________________________________

Please Note: 1. Membership dues are payable during the Membership Window for membership to be considered for
2. 3. approval. http://glenrockgurudwara.org/documents/Amendment.pdf For December 2013 Membership Window, the Membership fees are: Adults $10. Seniors (65+): $ 2. Proof of residence is required in the form of: a. b. c. New Jersey or New York Driver License, or Deed or Utilities Bill, or 3 months old Bank Statement, with a valid passport

Membership Renewal Questions

Please answer Y(Yes) or N(No) to following TWO proposals. (Old & New Constitution are on our web site for reference)

1.

I approve the Two Years membership and Two Years terms for Officer Bearer.

Yes:________No:_________

2. I approve the modified SGSS Constitution (http://glenrockgurudwara.org/documents/Amendment.pdf) dated Aug 5,

2011 that allows 2-year membership and correspondingly modified terms for office bearers. If approved (75% Voting 3. Yes), it will take effect immediately after close of membership window on Dec 31, 2012: Yes:___ No:__ Board of Trustee Chairman, President, Vice President, Secretary & Treasurer should be Amritdhari? Yes:___No:__ If No: than all the committee members should be Amritdhari?

Signature of Member:___________________________________________ Date: _____________ Membership Committee Approvals: Membership Dues Payment Details: Receipt# __________ Amount: _________ Date: _______________ Committee Members:(1) ____________________(2)_________________________ Date: __________________ Chairperson: ________________________________________________ Date: __________________