Name: ____________________________________________________

Address:__________________________________________________

City: _____________________ Prov:_____    Code:________________

Telephone:_________________________________________________

Fax/Email:________ _________________________________________

___Yes, I would like to support one of the Jamgon Kongtrul III Projects

Please find enclosed $_____ as a

Monthly_____ quarterly_____ annual_____ one-time_____ contribution for the following project(s):

1.     __________Jamgon Kongtrul III Memorial Home for the Destitute
        (Kalimpong, India)
        A donation of $20 covers the cost of one month ($240 for a year) for one resident

2.    _____ Jamgon Kongtrul Home for the Destitute
        (Népal)
        Donations of any amount are greatly appreciated 

3.    ____Jamgon Kongtrul III Memorial School
        (Kalimpong, India)
       A donation of $20 covers the cost of educating one child for a month ($240 a year)

4.    _____Jamgon Kongtrul III Memorial Health Care Centre
       Donations of any amount are welcome. $4000 will cover the cost of the doctor and the nurse for one year; the total budget for staff, medicines and supplies is approximately $15,000

5.   _____Help for the Treatable Blind Tilganga
        A donation of $25 covers the cost of giving the gift of sight to one person with surgery and interocular lenses.

Please return this form with your cheque or money order payable to:

Rigpe Dorje Foundation
503, 5e ave, Verdun, QC, H4G 2Z2
Canada