KHNA Directory Information
Please submit the information below to include in the directory. All fields are optional except the name, address and email information. Recipients of the convention newsletter "Anjali" will be automatically included in the directory unless opted out.
Check here to remove from Directory
Address
City State Zip Country
Home Phone Home Town In Kerala
E-mail
Spouse
Mr Dr Mrs First Name M.I Last Name
Home Town in Kerala
Children
1. Name E-mail 2. Name E-mail 3. Name E-mail 4. Name E-mail
Special instructions, if any:
Order Souvenir & Directory:
I am unable to attend the convention. Please send me a copy of the Chicago Convention Souvenir and the KHNA Directory by mail. I will be mailing a check for $50.00 towards the cost before April 30th, 2005 to KHNA, PO Box 112, Skokie, IL 60076.
Check here to Order:
