Registration Form

Please enter information in the form below to process registration for event Virginia Palkhi 2023.

First Name *

Last Name *

Email *

Address *

City *

State *

Zip *

Phone *

Spouse Name

Family gotra

Details of all family members (Gender, Name, Age)

Comment

I understand my commitment to visit at least 9 Palkhi homes and volunteer for the Palkhi event *

Yes

Amount

Payment Method

Paypal OR Debit/Credit card using PayPal Guest

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*