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Your Information
* Last Name (Required)
* First Name (Required)
* Middle Name (Required)
Email  
Spouse's Name
 Street
City
Province
 Country
Postal/Zip Code
 Home Phone
Alternate Phone
Your Parents Father's Name Father's Hometown
Mother's Name Mother's Hometown
Spouse's Parents Father's Name Father's Hometown
Mother's Name Mother's Hometown
Family Members living with you In Canada
Full Name Relation Date of Birth Marital Status
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YOU WILL RECEIVE AN EMAIL FROM THE SAMAJ TO CONFIRM THAT YOUR UPDATE HAS BEEN RECEIVED WITHIN 48 HOURS OF SUBMISSION. IF YOU DO NOT RECEIVE SUCH CONFIRMATION,
PLEASE SEND AN EMAIL TO anavilsamajcanada@gmail.com TO LET US KNOW SO APPROPRIATE ACTION CAN BE TAKEN.
THANK YOU.
Please Note:
• Information provided on this form will be available to every family in the Anavil Samaj of Canada.
• Please complete this form and press send information button below.
• If you are single, please complete box 1 under family members.

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