If you would rather mail in a copy of this form,
download the pdf file
.
I would like to make a credit card donation to the work of Susila Dharma International.
Amount in $US
First Name
Last Name
Street Address
City
State/Prov./County
Country
Postal Code
Telephone
Fax (Optional)
Email
Method of Payment
Visa
Mastercard
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Expiry date
Month
01
02
03
04
05
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12
Year
2005
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2007
2008
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2010
2011
2012
* Your donation will be converted to Canadian dollars at the current exchange rate.
Please earmark my donation to:
SDI General Fund, or
Project Grant Fund
Emergency Aid Fund
General Endowment Fund
Suhadha Scholarship Fund
SDI Service (specify below)
Member Project (specify below)
Please give name and address of person you are giving a commenorative gift to:
My donation is a commemorative gift for
Birthday
Anniversary
In Memoriam
Other
SD International is registered in the US and can issue US tax receipts. (Charity no. 98-0156249)
Please check the box if you wish a tax receipt.
Click to submit Donation
