TraiRatanaram Buddhist Temple membership form with fields for a member's first name, last name, sex, address, city, state, zip code, and signature. The form also has a checkbox to confirm being over 18 years old and spaces for a witness signature and receipt date.

1. TRAIRATANARAM BUDDHIST TEMPLE
21-25 Quigley Avenue, N. Chelmsford, MA 01863 (Tel. 978-251-2709)
MEMBERSHIP FORM
ADHOC COMMITTEE MEMBERS No. ________
:
First Name ________________ Last name _________________ Sex _____
____________________ _________________ _____
Address _____________________________________________
Dr. City _______________ State ___________Zip Code ____
Dr.
I, the above name, am very pleased to be an active member of TraiRatanaram Temple, Inc.
Age : 18+ Yes / _____ No _____
Signature ____________________ Date _____________________
Witness of volunteer member
Name __________________________ Signature _____________
Receipt Date __________________