Registration for performing Pooja                                                
Name of the Devotee :  
Gender :
Father's Name :
Mother's Name :
Spouse's Name (If applicable) :
Place of Birth :
Date of Birth :
Mailing Address

                           

City :
State :
Country :
Zip Code :
Phone : Mobile :
E-mail :
Special Instructions (If any)
Would you be Physically present at the Pooja : Yes No
If Yes, please mention total members who will accompany you :

Comments :


(If you want to provide your Gotra please mention here)
  • All information being asked for is to assist in Pooja / Rituals and will be kept strictly confidential.

 

     

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