(Please print out this page, fill out and mail or fax back to: Mahamudra
Centre, RD4, Main Road Colville, Coromandel, New Zealand. Fax No: 64
7 866 6851)
Membership Type (please tick)
Friend - $30 per month
Member - $50 per month
Benefactor - $100 per month
Patron - $200 per month
General Donation
Cheque Cash: please post with this form to above address
Credit Card Direct Debit
Please deduct the following amount
from my credit card:
Monthly $________ Yearly $_______
name on card :
card type
card # :
Expiry Date :
Signature:
Automatic Payment to: Mahamudra Centre for Universal Unity
Bank of New Zealand, Coromandel Branch, New Zealand
A/-# (incl. sort codes): 02-0304-0025397-083
Please debit my bank account for
the following amount:
Monthly $________ Yearly $___________
Bank
Account Name
Account #
Signature
Mahamudra Centre is a Charitable Trust and a Member of the Foundation
for the Preservation of the Mahayana Tradition (FPMT). FPMT is an international
organization that has over 140 centres and social projects worldwide.
