INDIVIDUAL CONTRIBUTION FORM

I would like to help the SUDARSANI EYE HOSPITAL - SEVA carry on its vital Gift of Sight to the poor and research programs. Please enroll me as a member of the "FRIENDS OF SUDARSANI EYE HOSPITAL"

Your generous donation will support :
Rs.1000 Cataract surgery on a Date of your choice/One eye donation
Rs.2500 One Free corneal transplant surgery on a day / date of your choice
Rs.5000 5 Cataract Surgeries /Obtain five eye donation
Rs.12500 One free corneal transparant Sugery on a day/ date of your choice every year for 5 years
Rs.25000 One free corneal transparant Surgery on a day/ date of your choice year for 10 years / 25 Cataract surgeries
Rs.50000 Free corneal transplant surgery for two patients on a day / date of your choice every year for 10 years / One Major Eye Camp with free Cataract Surgery for 50 Patients / 50 Cataract Surgeries


Name _________________________________________________________

Address _______________________________________________________

______________________________________________________________

City _______________________ Pincode ___________________________

State _________________________________________________________

E-mail ________________________________________________________

 

Make your tax deductible chque payble to the SUDARSANI EYE AND VISION ASSOCIATION (SEVA) and mail with this form to :

"SUDARSANI EYE AND VISION ASSOCIATION

SUDARSANI EYE HOSPITAL

Kothapet, Main Road, GUNTUR - 522001

Phone : 91 863 2220028

 

Click Here for answers to the question usually asked about donating your eyes...