Donate

Your contributions are very important to us. Your donations help provide medical treatment for the sick and needy.

All donations are tax deductible.

Your contributions could save someone from blindness or suffering caused by polio, T.B., rheumatic heart problems and many other diseases, some of which if left untreated could result into death.

MY TAX DEDUCTIBLE CONTRIBUTION TO HELP THE SICK AND NEEDY
Contribution:	[ ] $100	[ ] $250		[ ] $500	[ ] Other
Sponsor: Cardiac Surgery ($1,000/patient) or One Medical Faculty in memory of a Family Member ($2,500 to $5,000)

PLEASE MAKE CHECK PAYABLE TO:
JAIN CENTER OF SOUTHERN CALIFORNIA (Ref. Bidada Medical Camp)

Name___________________________________________________
Area Code/Phone _________________________________________
Address _________________________________________________
_________________________________________________________
E-mail ___________________________________________________

Mail check & form to:
Dr. Manibhai Mehta 11403 Tortuga Street Cypress, CA 90630 USA Tel: (714) 898-3156 Fax: (714) 893-0055 E-mail: manilalmehta@msn.com			=================================== *Thank you for your generous support* ===================================