DANA FORM

q   Cash donation of $__________________________

q   Monthly donation (cheques or credit card):
     Please contact the Treasurer about how to set up monthly donations.

     O $5   O $10   O $20   O $50    O $100   O other amount ________________
     Starting date:_____________________

q   Annual donation of $_____________ per year.   Starting date:_____________________

q   Interest free loan of $_________________________
     Starting date:_______________________________ Repayment:_______________________

q   Interest bearing loan of $______________________
     Starting date:_______________________________ Repayment:_______________________

- Make cheques payable to Vipassana Meditation Centre Tasmania
- Charge credit card:

VISA/Mastercard #:_______________________________exp. date:_______________________

Signature:______________________________________

q   Service/work to offer: construction skills, professional services, labor, cooking, etc:
     _________________________ _________________________ ________________________

q   Please send me more information about : ___________________________________________

Name__________________________________________________________
Address________________________________________________________
City________________________ State ______ Postal Code___________
Telephone___________________ Email (optional)_______________________________________

Mail to: Treasurer, Vipassana Meditation Centre Tasmania, GPO Box 6, Hobart TAS 7001, Australia
Tel. [61](3) 6263 6785; Email: [email protected]