Lama Osel's Education Fund

Pledge Form

Name : ______________________________________________________

Address : _____________________________________________________

______________________________________________________________

Postal Code : ____________________

City : _______________________

District/State : ___________________

Country : _____________________

Please circle the options chosen :

- I would like to help financially support Lama Osel and would like to make a regular contribution :

- monthly

- quarterly

- yearly

- once

for the amount stated below :

- 20 $

- 25 $

- 30 $

- 40 $

- 50 $

- 100 $

- ______________________________ (please specify a different amount or a different currency)

Please charge my : - Bankcard - Visacard - Mastercard (please circle one)

Card number : _______________________________________________

Expiry date : ________________________________________________

Signature : ________________________________________________

Please return this form to:

Lama Osel Support Fund

FPMT International Office
125 B La Posta Road
Taos, NM 87571 USA

Telephone (505) 758-7766
Fax (505) 758-7765
Email fpmtinfo@fpmt.org