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YES! I WANT TO BE A SPONSOR! Please print this form and mail to address below..Thank You! Please complete Sponsor Information ( * required fields) * First Name: * Last Name : Street: City: State: Zipcode: Phone: * Email: Please complete Sponsor Option (cost per year in US Dollars / Indian Rupees) Sponsor a child - $150 / Rs6500 Snacks - $100 / Rs 4000 School Uniforms per child - $25 / Rs1000 Teacher's Monthly Salary - $115 / Rs4500 Stationary $375 / Rs 15000 Maintainence - $750 / Rs30000 Field trips/Sports - $375 / Rs15000 Vocational classes - $375 / Rs15000 Other - Enter Amount in US $ / Indian Rupees Please print and mail completed form with donation check( made to 'Jeevan Pushp Charitable Trust') to: JEEVAN PUSHP CHARITABLE TRUST,(Attn: Jayshree Rao) 137 Kuber Complex, New Link Road(opp. Lakshmi Industrial Estate), Andheri(w) Mumbai - 400053, India. ( phone: 26735100 ) ALTERNATE U.S ADDRESS : 20125 Pierce Road, Saratoga, CA-95070

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