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DAYAKA SABHA MEMBERSHIP FORM
Sarodaya Buddha Vihar, Tilak Nagar, Chembur, Mumbai - 400
089

THE VOW OF BLESSING FORM
(
Sign Indicates the fields are compulsory)


I would like to become a member of the Dayak Sabha for the cause to uplift the under privilege people and propogation of Noble Dhamma.
For doing so, Today i am solemnly taking a heartful oath with deep devotion that i will support the cause by donating 80 cents (eighty cents only)
per day for next three years, from my own earning.
Now donating $ (in words)
I Mr./Mrs./Ayu./Ven. (full name)
Age
Qualification
E-mail
Address (full address)
Occupation
Telephone (R)
Telephone (Off)
by Cash Cheque. Drawee Bank
Cheque No.


For International donations and financial assistance form
For International Convenience all account charges may be made in Dollars
Or Payment by Wire Transfer :

I Enclose my Cheque, International Money order or Euro Cheque made payable to:
"BHIKKHU SANGHA'S UNITED BUDDHIST MISSION" A/c No. 4472
The Maharashtra State Co-operative Bank Ltd, Tilaknagar Chembur, Mumbai 400 089, INDIA.


Please Charge my credit card below in the total sum of

Card Name : American Express Master Card Visa
Card No. :