* Required information

First Name: *

Last Name: *

Place of birth: *

Year of birth:

Do you work?
(indicate work-place and position)

Do you attend a university? (indicate the institution and faculty)

Work or School address :

Contact address: *

E-mail:*

Mobile Phone:

Fax:

Attn.: Other Nationals of Kartvelian (Georgian) Origin

Through whom is your Georgian relationship?

What is your Nationality :

Do you know any of your Georgian last name(s)?

Your Georgian last name(s) :

Do you have children?

How many boys?

How many girls?

Do you know at least one of the Georgian languages?

Which language?

How well?

Do you want to study Georgian?

Do your children want to study Georgian?

Part III

Have you read the articles of the CRKC?

Have you read the Membership information?

Do you agree to abide by our terms of agreement?