| Name:
[Mr/Mrs/Ms/Miss/Dr/Rev]
|
| Street
Address:
|
| City:
|
| State:
|
| Zip:
|
| Home
Telephone:
|
| Office
Telephone:
|
| E-mail
Address:
|
| The
sum of $
is being submitted for the following purpose: |
|
Donation/Contribution of $
in remembrance of
to invoke |
| blessings
upon
|
Dana to the Maha Sangha of the Dharma Vijaya Buddhist
Vihara |
| $
Monthly
Dana |
| $
Lump
sum given in Lieu of Monthly Dana |
Please
reserve the following date and time for my/our
Dana: |
| Date:
Time:
AM/PM |
|
Monthly Donation & Membership |
| $
for
the maintenance of the Dharma Vijaya Buddhist |
Vihara,
Los Angeles, California; the upkeep of the Maha Sangha;
and membership in the Vihara. |
| Date:
Signature:
(type name)
|
| |
| (Please
make check payable to: Dharma Vijaya Buddhist Vihara) |
|
|
