Donation for Building Fund
 Please see previous page for a key on how your contribution will be used
 
Name :
Full Address :
Country :
Phone :
Email / Website :
Occupation :
Company :
Designation :

Are you interested in participating in future KYM’s Programs?
Yes No


I would like to support the KYM building fund by donating:
(please tick one of the following)
US$4000 US$2000 US$1000 US$500
US$400 US$300 US$250 US$200
US$100 Others (please specify)



I am enclosing above payment through
Draft / cheque #
     Dated                
made payable to “ Krishnamacharya Yoga Mandiram – Building Fund”.
     Credit card type
     Card Number
     CVV Number
     (Three digit number on the reverse of the card)
     Expiry date

(Note: We only accept Visa/master card and American Express, if you are paying through credit card, please send us a copy of the front and back of your card along with this form and a copy of your government issued id to safeguard against fraud.)
 

  

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