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Person Details:
Please Note that * Denotes Required Field!
First Name* : Last Name* :
Home Phone* : Cell Phone :  
Email* :      
Street* : City* :  
State : Zip Code :  
Gothram : Nakshathram :  

Family Details:
First Name Last Name Relationship Gothram Nakshathram

Sponsorship Details:
If you are unable to attend in person, our priest will include your names during sankalpam for your sponsorship. Feel free to contact us at info@qchindutemple.com.

(Please select the sponsorship)
Sponsorship Amount
Ganesh Chaturthi - Grand Sponsor
Ganesh Chaturthi - All Days Pooja
Ganesh Chaturthi - Abhishekam
Ganesh Chaturthi - Homam
Ganesh Chaturthi - Satyanarayana Pooja
Ganesh Chaturthi - One Day Pooja

Total $

Check Number : Check Date :  

(Please DO NOT send Cash. Pay only at the Temple)

(Please send the Check)

(Please make your check payable to Quad City Hindu Temple)