|
Membership |
Last Name:
__________________________________________ |
| [
] Benefactor $50,000+ will
pay in [ ] instalments in
5 yrs |
First Name(s):______________________________ |
| [
] Grand Patron $10,000+
will pay in [ ] instalments
in 3 yrs |
Children's
Names (ages): |
| [
] Patron $5,000+ will pay
in [ ] instalments in 2
yrs |
|
| [
] Life Member $1,000+ will
pay in [ ] instalments in
2 yrs |
|
|
[
] Donation $ __________________________________
|
|
| |
|
|
Temple Expansion Project
(Sri Rama & Sri Siva Temple area) |
|
|
[ ] Donation $_______________ |
Address: ______________________________ |
|
______________________________________ |
| |
______________________________________ |
|
Yagnasala Project |
|
|
[
] Donation $ _______________ |
|
|
|
|
|
Community
Center Project: |
|
| [
] Donation $ _______________ |
|
| |
Telephone
#: __________________________ |
|
Priest
Quarters Project: |
E-Mail:
_______________________________ |
| [
] Donation $ _______________ |
|
|
|
| Payment
Method____________Check____________________ |
|
| Visa
No.________________________________Exp.Date_________ |
Date:
_________
|
|
|
Signature(s)
__________________________ |
|
|