PLEDGE FORM

Name  
Nationality  
Address  
State  
Country  
Zip/Pin Code  
Telephone No  
Fax No  
E-mail Address  
Amount of Donation  
MAKE CHECKS PAYABLE TO INDUS MEDICAL FOUNDATION
Indus Medical Foundation
Indus Drive, Mount Jakhoo
Shimla- 171 002, India
Mode of Donation  
Draft No  
Date :  
   

 

image
Contact us for more info