Individual Registration

Please enter information in the form below to process registration for event Shri Dwarkamai Weekly Garland Sponsorship.

First Name *

Last Name *

Address

Address 2

City

Phone *

Email *

Comment

Gothram

Nakshtram for family members

Sponsorship *

Ganapati Garland ($51)

Durga Mata Garland ($51)

Vasavi Mata Garland ($51)

Lord Shiva Garland ($51)

Baba Garland ($101)

Balaji Garland ($101)

Navagraha Garlands ($101)

Amount

Payment Method

Paypal / Credit Card / Debit Card : : (All through Paypal Interface)

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*