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TODAY's Date _______________

TO:

India House of Worship

1428 Chilton Drive

Silver Spring MD 20904

We apply for IHOW membership with approprite donations as follows:

[ ] Annual Membership $25 [ ] Hindu Temple Fund ($100 minimum)

[ ] Donation (any amount) [ ] SAMSKAR Sponsorship (please call)

[ ] LIFE Membership $351 P.S. Members receive SAMSKAR FREE of Cost

Print Full Name ________________________________________________________

Street Address ________________________________________________________

City State & ZIPCODE ___________________________________________________

Home Phone: __________________ Occupation ____________________________

Spouse Name __________________ Occupation ____________________________

e-mail _______________________ FAX: ____________________________

We understand that all contributions to IHOW are tax-deductible to the fullest extent allowable by the IRS Laws and that you have our permission

to publish the above information.

EIN TAX ID: 52-1069-789.

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