4. I wish to sponsor health (general health | blood donation) camp(s): Camp(s) (Number) Amount (`) Please tick your choice 1 50,000 2 1,00,000 3 1,50,000 Other, _____ _____(@ ` 50,000 per camp) 5. I wish to construct amenity blocks in a village: Amenity block(s) (Number) Amount (`) Please tick your choice 30 5,00,000 60 10,00,000 90 15,00,000 Other, _____ _____(@ ` 16,800 per amenity block) 6. I wish to donate ` _______ towards the corpus of Atul Rural Development Fund. My contact details are given below: Name:_______________________________ Home | Office address: _____________________ _________________________________________________________________________________ E-mail address:_____________________________ Mobile telephone: ____________________ The donation amount may be remitted, along with the requisite information with respect to how you wish to participate (project, corpus, etc), by drawing a cheque in favour of Atul Rural Development Fund and sending it to Dr Rana Vishnoi or through RTGS as per the details given below: Beneficiary: Atul Rural Development Fund Bank: State Bank of India Branch: Atul Account number: 10259739167 IFS code: SBIN0001657 31
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