APPLICATION FOR THE VISIT OF DURGA TEMPLE

(Fill out completely, please Print or Type by each individual in visitor group)

ALL INFORMATION IS REQUIRED

Action Requested :

Visitor’s Information (name must match your government issued ID):







All school and student visitors must complete followings Section:

All Corporate initiated event must complete following section:
If this person is a minor,list the name, address, and phone number of the child’s custodial parent or legal guardian:
I STATE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
5/28/2017
Date