Agraharam Membership Form

KAILASA GOWRI NOMU - SANKALPAM and UDYAPANA - Date: 6th Sep 2025 Venue HSNC Temple Hall - For details contact Smt. Vidya Kolanu 919-389-5274

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Email (for username)

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First Name

Last Name

Date of Birth:

Select Your Nakshatram

Select Padam

Select Raasi

Phone

Select Vedam

Gothram

Marital Status

Date of Marriage:

Spouse First Name

Spouse Last Name

Spouse Date of Birth

Spouse Nakshatram

Spouse Padam

Spouse Raasi

Spouse Phone

Select children

House Number

Street Name

City

State

Zip Code

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