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Annadan Seva 2017 Registration

 Please fill in the form below and hit the register button. 
You are visiting us from: Woodbridge, NJ, United States
Note: * indicates mandatory
Section 1.Please Enter your Information
First Name:     *
Last Name:    *
Address1:    *
Address2:   
City:    *
State:     *
Zip:    *
Country:    *
Mobile Phone:    *
Land Phone:   
Email ID:    *
Section 2. Your Contribution for Annadan Seva
B. Enter your Contribution amount:   USD 
You May contribute securely Online or By Check
To contribute online fill in the following details:
A. Please Check Card Type  Visa     MasterCard     Discover     American Express 
B. Credit Card Number:     
C. Credit Card Expiration Date: (mm/dd/yy) or 
    (mm/yy) format only,
  
D. Credit Card Holder Name:    
E. Credit Card Code (3 or [4 digit code for AX] from back of Card):    
Write your comments if any:   

Section 3. Signature:

 
Signature:   * Signature Date(mm/dd/yy format):   *
   
Entry Confirmation(Captcha):
To confirm that you entered the data above, enter the six character code from the left column.
*
   
Click the register buttion below to register online
To donate by Check make check payable to "Shirdi Sai Baba Sanstha", print and fill this form and please mail along with check to Shirdi Sai Baba Sanstha, 12N950 IL Route 47, Hampshire, IL 60140, USA
   
All Donations if made in USA are tax deductable under IRS Section 501(c)(3). Tax ID 36-4400449. Please consult your tax advisor for details and your eligibility.
   


Note:
If you face any technical problems while submitting this form.
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