Prayatna India

How to Help

DONATION - FORM

Prayatna
An Environment Action Group
Regd.Off :L-2, B.D.A. Flats, C-Sector,Shahpura, Bhopal-462039 (M.P.)

I would like to support PRAYATNA in its effort to carry out its work against Pollution & Polythene for a pollution free world. Please find my check in the amount of Rs._____________________

First Name________________________________________________________________________________

Last Name________________________________________________________________________________

Address 1_________________________________________________________________________________

Address 2_________________________________________________________________________________

City______________________________________________________________________________________

State _____________________________________________________________________________________

Zip/Postal Code_____________________________________________________________________________

Country___________________________________________________________________________________

Phone____________________________________________________________________________________

Email Address______________________________________________________________________________

Comments or Questions for Prayatna:

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Date ___________ Signature__________________

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