Contribute - How you can help - Sponsoring Prostheses

CPAA

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Sponsoring Prostheses

Yes, I would like to sponsor the following prostheses for a cancer patient.

Please have a representative contact me.

	Magic Slate(s) @Rs. 60 (US $ 5)
	Breast Prostheses @Rs. 350 (US $ 15)
	Jaw Stretcher @Rs. 400 (US $ 15)
	POP Protective Prostheses @Rs. 600 (US $ 20)
	Maxillar Protective Prostheses @Rs. 1000 (US $ 35)
	Dental Protective Prostheses @Rs. 1800 (US $ 60)
	Orfit Protective Prostheses @Rs. 3000 (US $ 100)
	Larynx Prostheses @Rs. 12,000 (US $ 400)
	Limb Replacements @Rs. 24,000 (US $ 800)
	Gotex Net Prostheses @Rs. 57,000 (US $ 1900)
	Knee Replacements @Rs. 3,80,000 (US $ 13,000)

Name:
Title (if any):
Organisation (if any):
Address:
City:
Pincode:
Tel No.:
Fax No.:
E-mail

PAYMENT METHOD
Check the method of payment that you are using
Demand Draft (DD)
Cheque

DD / Cheque Number:
Date:
Issuing Bank:

Please send Stamped receipt for the donation to:
Address:
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