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SRI RAJA RAJESWARI AMBAL DEVASTHANAM Kannakaipuram, Ward No.10, Pungudutivu, Sri Lanka. Tel: 021-3207690

MEMBERSHIP APPLICATION FORM

Sri Raja Rajeswari Devasthanam Membership is open to all members of our community inside and outside of Sri Lanka. The Trustee Board of Sri Raja Rajeswari Devasthanam is dedicated to perform

several community works as well as in manages and carries out the temple and its properties successfully. Membership dues are Rs. 1000.00 per month and payable ar the end of the month or once a year. Payment could be made by cash or cheque. Foreign donors also may deposit their money directly to the Bank Accounts. Please feel free to contact our treasurer for further details or visir to www.pungudutivutemples.com. All well-wishers and donors are kindly invited to contribute and become a member. A member of the Trustee Board has the rights to vote and contend in the Annual General Meeting (Maha Shabai)

Thank you Trustee Board of Sri Raja Rajeswari Ambal Devasthanam

Please complete the following

Full Name : Mailing Address:

Telephone no: Mobile:

E-mail:

Date of Birthday: Date Month Year

Mode of Payment: Cash Cheque Bank Deposit

Payment Method : Monthly Yearly

I would like to be a member of the Kannakai Amman Temple

Date Signature

Colombo Office:

Please return the completed form with your payment to Sri Raja Rajeswari Ambal Devasthanam

No.72, Wolfendhal Street, Colombo 13, Sri Lanka. Tel: 011-2431641, 011-2336565 Fax: 011-2433781

Email: kannakaiambal@gmail.com

Bank Account:

Sri Raja Rajeswari Devasthanam

A/C. NO. 1120029401 Commercial Bank,

Pettah Branch, Colombo-11,

Sri Lanka

Thank You for Your Support

Web: www.pungudutivukannakaiamman.com Email: kannakaiambal@gmail.com