Loka Dharma Seva Foundation of America
Membership Registration for Participation in the Services of LDSF
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Name: ___________________________________________________
Address: ___________________________________________________
Address: ___________________________________________________
City / (P.O.): ___________________ State: ___________________
Pin / Zip code: ________________ Country: _________________
Phone Number: ________________ E-Mail: __________________
Past Activities of Service for Indian Tradition and Culture:
[ ] Please register me as a member of LDSFA for participation in the services of LDSFA:
[ ] I do not want to be a registered Member of LDSFA but will help in the projects;;
[ ] I will participate in its activities and Donate/Pledge funds to LDSFA as below:
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Donation / Contribution offered and pledged:
US $ - o $25 - o $100 - o $350 - o $1,000 - o $ __________
US $ - o $50 - o $250 - o $500 - o $2,500 - o $ __________
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Interested in the following Programs / Projects:
o 1 a. Arranging Faith Based Community education in USA
o 1 b. Construction of the Congregation Hall with classrooms in India
o 2 a. Arranging Single Teacher Tutorial classes for 5 to 12 year old students;
o 2 b. Arranging Health Camp and Health Education for Lifestyle Modification;
o 3 a. Organizing Faith based Vocational Training and classes in several cities in India
o 3 b. Arranging Faith Based Eco-Tourism programs for all in USA and in India
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I am enclosing a Check for: [ US $ ] : _______________________
Thank you, Sig.: ______________________________________
Date: ______________ Name: _____________________________________
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Please make your check: payable to: “ Loka Dharma Seva Foundation of America” and mail to:
Dr. Bala N Aiyer, M.D.
2014 Vista Lake Court
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You may send this information by e-mail to:: bnaiyer@yahoo.com
- ** Please note that Membership in LDSFA or its Board Committees is by invitation only
- Membership will be decided based on need, past services and support for LDSFA Activities.
- There are no Membership dues, but donations, general and for specific work are welcome
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All your contributions will be controlled by Audits, Checks and Balances by LDSFA
Please contact us for more information:: -- :: Dr. Bala N. Aiyer, M.D. : 281-302-6112
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