Member Sign UP – රෝහල් සේවා මණ්ඩලය

In order to sustain the activities of Hospital Services Council(HSC) you are kindly invited to be a member of HSC
and donate a fixed annual amount in your chosen currency. (We accepts Sri Lankan, US, British, Canadian, Australian, Euro, NZ, Japanese, Malaysian and Singapore currencies)

Name: *
Email: *
Telephone: *

Postal Address

Street:

Suburb:

State/Province:

Post Code:

Country: *

Currency: *

Amount:

Purpose/Notes (if any):

eg: Passing merits to departed, helping sick, celebrating an event. You may provide the day
and month as well. Otherwise, please feel free to give us a brief message here

Human Verification: *
+ 3 = 5