Donor Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=3 height=120 BGCOLOR="#FFCCFF" TEXT="#080000" bgproperties="fixed" background="05a3f781egdyul.gif"> <div> <B>Donor Form</B></div> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="index.htm" TARGET="_top" TITLE="Sangam Village Home Page"><U><B>Sangam Village Home Page</B></U></A><B>   |   </B><A HREF="id17.htm" TARGET="_top" TITLE="Vision Introduction"><U><B>Vision & Introduction</B></U></A><B>   |   </B><A HREF="id18.htm" TARGET="_top" TITLE="The Project"><U><B>The Project</B></U></A><B>   |   </B><A HREF="id34.htm" TARGET="_top" TITLE="News Items"><U><B>News Items</B></U></A><B>   |   </B><A HREF="id29.htm" TARGET="_top" TITLE="Sangam Museum"><U><B>Sangam Museum</B></U></A><B>   |   </B><A HREF="id30.htm" TARGET="_top" TITLE="Community Centre"><U><B>Community Centre</B></U></A><B>   |   </B><A HREF="id20.htm" TARGET="_top" TITLE="Committee"><U><B>Committee</B></U></A><B>   |   </B><A HREF="id31.htm" TARGET="_top" TITLE="Museum Display Items"><U><B>Museum Display Items</B></U></A><B>   |   </B><A HREF="id28.htm" TARGET="_top" TITLE="Photographs"><U><B>Photographs</B></U></A><B>   |   </B><A HREF="id19.htm" TARGET="_top" TITLE="Upcoming Events"><U><B>Upcoming Events</B></U></A><B>   |   </B><A HREF="id43.htm" TARGET="_top" TITLE="Financials"><U><B>Financials</B></U></A><B>   |   </B><B>Donor Form</B><B>   |   </B><A HREF="id26.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A><B>   |   </B><A HREF="id27.htm" TARGET="_top" TITLE="Contacts"><U><B>Contacts</B></U></A></div> <bR> <div> </div> </td> </tr><tr> <td valign="top" rowspan="2" width=200 BGCOLOR="#CCFFFF" TEXT="#080000"> <bR> <div> Please  print this form, complete it, and fax it back to us.</div> <div> Your support is appreciated.</div> <bR> </td> <td valign="top" height=325 colspan=2 BGCOLOR="#FFFFFF" TEXT="#080000"> <bR> <div> <B>Donor Form</B></div> <bR> <div> <B>THEN INDIA SANMARGA IKYA SANGAM - LAUTOKA BRANCH</B></div> <div> <B>P O Box 144, Lautoka, Fiji Islands .  Phone: +679 666 0199 . Fax: +679 666 0761 </B></div> <div> <U>Lautoka Branch</U></div> <div> ___________________________________________________________________________</div> <bR> <div> LAUTOKA SANGAM VILLAGE<FONT SIZE="4" COLOR="#009900" FACE="Arial" > </FONT><FONT SIZE="3" COLOR="#009900" FACE="Baskerville" ><B>a Millennium Project</B></FONT></div> <bR> <div> “ BRINGING TOGETHER SANGAM MEMBERS & THEIR FAMILIES AND FRIENDS TO INTERACT IN HARMONY”</div> <bR> <div> <B><U>DONOR CONTRIBUTION FORM </U></B></div> <bR> <div> FAMILY OF  </div> <bR> <div> Mr. & Mrs______________________________________________along </div> <bR> <div> With______________________________________________________ </div> <bR> <div> of ____________________________________ Phone:______________</div> <bR> <div> Address <FONT SIZE="3" COLOR="#000000" FACE="Arial" >_________________________________________________________ </FONT></div> <bR> <div> Fax:_______________eMail:__________________________________________</div> <bR> <div> _____________________________________________  are pleased to participate</div> <bR> <div> As Donors in the Lautoka Sangam Village Project with donation of sum of </div> <bR> <div> $ ___________________   [________________________________________]</div> <bR> <div> To be paid in full / installments of initial sum of $________ to be followed by sum </div> <bR> <div> of $_______________ at intervals of _____________month or otherwise as follows</div> <bR> <div> _____________________________________________________________________</div> <bR> <bR> <bR> <div> _____________________________________ ____________________________</div> <div> Signature of Principal members of the family Name</div> <bR> <bR> <div> Dated ______________________________</div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="627" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="310"><div> For Office Use :</div> </tD> <tD VALIGN=TOP WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <bR> </td> </tr><tr> <td valign="top" colspan=2 height=35 BGCOLOR="#CCFFFF" TEXT="#080000"> <div> LAUTOKA SANGAM VILLAGE -<FONT SIZE="2" COLOR="#009900" FACE="Arial" > </FONT><FONT SIZE="2" COLOR="#009900" FACE="Baskerville" ><B>a Millennium Project</B></FONT></div> <div> “ BRINGING TOGETHER SANGAM MEMBERS & THEIR FAMILIES AND FRIENDS TO INTERACT IN HARMONY</div> </td> </tr></table></body>