SRRP - Pooja Sankalpam Request Form 
Sri Maatre Namaha, thank you for giving us the opportunity to help you on this spiritual path. 
Based on your interest, please select the option and submit the form. 

Important: Donations are optional, and all information will be completely secured.

Email *
2. Your Full Name
 *
This is the name of the person filling this form
3. Full Name (for Sankalpam)
This is the name of the person whom we need to sankalpam. 
3. Phone Number *
Phone Number (With Country Code), Like +1 612-111-3333, +91 98675-67892, +44 2222-3333
4. City  *
5. Event *
6. House Owner Details 
 *
Married girls, please give your husbands' full names. 
For doing Sankalpam/Pooja, please provide details in the following format. 
        Goutram - Nakshatram - Rasi - Full Name  
(Ex: Bhardwaja - Bharani - Mesha - Gade Venkata Reddy)
6.  (Optional) Family member details 
Please provide details if you would like to add details of your family members to Sankalpam/Pooja. 

Note:
1.  If you dont know Gotram  or Nakshatram or rasi, please mention that as "Subha" 
2. If you don't have deatils,  enter N/A if not applicable. 
3. Please provide their details in relation to the homeowner. 
Example: Relation with house Owner - Nakshtram- Raasi - Full Name 
Ex: 1. Wife:             Hasta - Kanya - Sumati Pasupuleti
      2. Son1:            Makha - Simha - Aditya Pasupuleti    
      3. Daughter1:  Rohini - Vrushabha - Sridevi Pasupuleti
8. (Optional) Any specific reason for Sankalpam
Any specific reason/issues you want us to mention while doing for Sankalpam? Enter N/A if not applicable.
Ex:
1. For our family well-being and relationships 
2. Pay for my son/Daughter Sri Krisna, as he is having a physical challenge.
3. Pray for Mr. Suesh Challa, who is undergoing heart issues. 
4. For my friend Suhantha K, going through family/personal issues
2. For Loka-Kshmam, for any specific issues 
Please provide details of the person with his name and date of birth, place of birth, and what specific help you are looking for that person to pray for him/her.

8.   (Optional) Any plans to perform pooja at Your house?
Please let us know. If you have any plans to do any poja at your house with a tentative date
9.  (Optional)  Your Address
If you want to host the event, or if you want to receive Homa Raksha/Akshtas/Prasadam over mail/post? 
Ex.: Suresh Kalidindi, 12345 Main St, Frisco, 75025, USA
10.  (Optional)  Donation to Peetham 
This is completely optional, and if you are doing it, please mention details for our tracking. 
If you would like to support/donate or volunteer to SRR Peetham towards various spiritual events (like Homam, daily activities, flowers, Naivedyam, temple construction, etc.) https://srirajarajeswaripeetham.org/donate/ 
A copy of your responses will be emailed to .
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