Membership Form

Karuna Charities Washington, Inc., P.O. Box 60241, Potomac, MD 20859

Name(s) :
Address :
City :
State/Zip :
Phone # :
E-mail:

                          
  Membership Fees

Life Member	$150.00
Friend of Karuna	$50.00
Donation
Enclosed	$———

Please make your check payable to Karuna Charities Washington, Inc.

Mail this form to:

Jasbir Sethi, Treasurer
Karuna Charities
P.O Box 60241
Potomac, MD 20859