Pampa Kannada Koota Membership / Renewal Form

IRS has approved tax-exempt status of Pampa Kannada Koota.
Our IRS ID : 38-2669587
Now, your donations to Pampa Kannada Koota are tax deductible. 

Annual Membership: Family: $35; Individual:$25; Life membership: $350 

  First Name Last Name Occupation
Name:      
Spouse:      
Children: (Indicate First Name & Last Name)
1.      
2.      
3.      
Senior Citizens:
1.      
2.      
Address: Street:
  City: State: Zip:
Phone:  
E-mail:  
  Please include an e-mail address where we can send information about our activities.
Interests:
  Music: Dance: Drama:
  Sports: Others:
Note: The above information will be published in a Pampa Kannada Koota Association member directory. If you have any objection to including any of the above information like Phone No., etc. in the directory, please indicate so now. We will do our best to protect the privacy of the email list of all the members
Payment Details: Amount: Cheque No.: Date:
  • Print this Form
  • Complete the Form
  • Mail the Form along with the check payable to "Pampa Kannada Koota" to the following address:

    Raghava Puttaswamy
    23164 Julieann Court
    Farmington Hills, MI 48335
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Pampa Kannada Koota can be contacted at
info@pampakannadakoota.org