AAKASH FERTILITY CENTER & HOSPITAL
Mail Donation Instructions

Mail donations can be handled in two ways:

* Simply mail a cheque to the address listed below
* Mail your contribution using the form on this page

Aakash  Institute Of Fertility & Research
No. 10 Jawaharlal Nehru Road (100 Ft Road)
Opp. Ambica Empire Hotel, Vadapalani,
Chennai - 600 026,
TamilNadu,
India

I would like to contribute to the AAKASH FERTILITY CENTER & HOSPITAL

Enclosed, please find my check in the amount of $___________.

(Please print)

Donor:

Name:______________________________________________________________

Street Address:_______________________________________________________

City:_______________________________________________________________

State:_______________________________________________________________

Zip:________________________________________________________________

Daytime Phone: (optional)_______________________________________________

Evening Phone: (optional)________________________________________________

If you would like to make a donation in memory or in honor of a loved one, please complete the following information:

Please Check One:

[ ] In Memory of: _____________________________________________________

or

[ ] In Honor of: _______________________________________________________



Send acknowledgment to:

Name:______________________________________________________________

Address: ____________________________________________________________

___________________________________________________________________

Phone: _____________________________________________________________



and



Name: _____________________________________________________________

Address: ____________________________________________________________

___________________________________________________________________

Comments or specific Instructions:_________________________________________

___________________________________________________________________