2021 MVBT Membership Form

MVBT Membership Categories beginning January 1, 2021

Sustaining Family
- Definition: 2 adults in a household that may include children under the age of 26
- Benefits: Full Temple benefits
- Annual Dues: $1,000. Note: The additional funds help to sustain MVBT
Family
- Definition: 2 adults in a household that may include children under the age of 26
- Benefits: Full Temple benefits
- Annual Dues: $600
Sustaining Individual
- Definition: 1 adult in a household that may include children under the age of 26
- Benefits: Full Temple benefits
- Annual Dues: $500. Note: The additional funds help to sustain MVBT
Individual
- Definition: 1 adult in a household that may include children under the age of 26
- Benefits: Full Temple benefits
- Annual Dues: $300
Associate Individual
- Definition: 1 adult between the ages of 26-35
- Benefits: Full Temple benefits
- Annual Dues: $150
Young Adult Individual
- Definition: 1 adult between the ages of 18-25 or full-time student
- Limited Benefits: Access to MVBT affiliate organization. No facility rental privileges
- Annual Dues: $25
Community Individual
- Definition: 1 adult with limited Temple benefits
- Limited Benefits: Access to MVBT affiliated organization. No privileges to zone membership, facility rentals, nokotsudo or funeral (sodan) arrangements
- Annual Dues: $120

2021 MVBT Membership Form
Is this a new membership or a renewal? *

New Renewal
Which membership category would you like to join for 2021? *

Sustaining Family - $1,000 Family - $600 Sustaining Individual - $500 Individual - $300 Associate Individual - $150 Community Individual - $120 Young Adult Individual $25
Additional Donation (Optional)

Household Information
How many adults will be included in this membership? *
How many children (under 26) will be included in this membership? *
Household Address (Number and Street) *
Street Address
Household City *
City
Household State *
Household Zip Code *
Zip Code
Primary Household Phone Number *
Please enter a valid phone number.
Would you like to receive a paper copy of The Echo? (MVBT Monthly Newsletter) *

Yes No

Household Members

Please list the names and email addresses for the members of your household. One adult email is required per household.

If you are submitting this membership form on behalf of a family member or friend who does not have an email address, you may assign a proxy to receive email on behalf of this member. If this applies to you, please indicate so in the field provided.

All other contact information on this page is optional. Each email address (including childrens') provided will be automatically subscribed to our "Putra's Post" e-newsletter. You may unsubscribe at any time.

Everyone listed below with an email address will also receive a follow-up survey that will give you the opportunity to provide additional contact information and information about interests and skills.
Adult #1 First Name *
First Name
Adult #1 Middle Initial
Middle Initial
Adult #1 Last Name *
Adult #1 Email *
example@example.com
Check below if applicable

The email address above belongs to a proxy (family member or friend delegated to receive email on behalf of this member)
Proxy Name and Relationship
Adult #1 Cell Phone
Please enter a valid phone number.
Adult #2 First Name *
Adult #2 Middle Initial
Adult #2 Last Name *
Adult #2 Email
example@example.com
Adult #2 Cell Phone
Please enter a valid phone number.
Child #1 First Name *
Child #1 Middle Initial
Child #1 Last Name *
Child #1 Email
example@example.com
Child #2 First Name *
Child #2 Middle Initial
Child #2 Last Name *
Child #2 Email
example@example.com
Child #3 First Name *
Child #3 Middle Initial
Child #3 Last Name *
Child #3 Email
example@example.com
Child #4 First Name *
Child #4 Middle Initial
Child #4 Last Name *
Child #4 Email
example@example.com

Household Emergency Contact(s)

In the event of an emergency, the adult members of this household will always be the first emergency contact for any other adult or child in the household.

For additional safety and insurance purposes, please provide the name and contact information for at least one additional adult outside of your household. You may also provide alternate emergency contacts in the space provided.

The household emergency contact information will be stored in printed form at the temple office and in a secured centralized database accessible by authorized temple personnel.
Emergency Contact Name *

First Name Last Name
Emergency Contact Relationship *
Emergency Contact Phone *
Please enter a valid phone number.
Alternate Emergency Contacts (Name, Relationship, Phone Number)

Temple Directory

As part of your membership you will be listed in the Mountain View Buddhist Temple Guidebook and Directory. This valuable resource is given to all Temple members when their membership is renewed. It is a guide to our organizations, services, programs, and a resource for connecting with others in the Temple.

Your name, address, primary phone, email, and cell phone will be included in the MVBT Guidebook and Directory. Select items below to Opt-Out of the directory.

CLICK HERE to view the Mountain View Buddhist Temple Privacy Policy.
Opt Out - Please do not print the following in the Temple Directory

Household Address Household Telephone Adult E-Mail Addresses Adult Cell Phone Numbers
NOTE: Email addresses for children will never be printed in the directory. They will only be used to deliver Putra's Post and temple announcements relevant to youth (ex: Dharma School events and meetings).
Toban Zone Preference

Toban Zones are assigned based on geographic location or personal preference. If you have a preference of zone assignment, please indicate so below.
Zone Preference (optional)

Payment Information

Membership Dues - {sfdcMemberLevel}	$ {categoryCalc}
Additional Donation	{additionalDonation}
Total Due	{totalPaymentCalc}

Payment Options:

In order to make our membership more accessible this year, we are offering the following options.

Pay in Full: Your full membership dues for the year may be paid today, either by check or credit card.
Pay in Installments: You may spread out the cost of your membership dues into either semi-annual or quarterly installments. If you select this option, you will be sent an email with further instructions.

If you need financial assistance, please contact the membership committee or Reverend Mukojima at reverend@mvbuddhisttemple.org.

How would you like to pay?

Pay in full by Check Pay in full by Credit Card Pay in 2 installments Pay in 4 installments
How would you like to pay for your first installment?

Check Credit Card
Pay by Check

After you click "submit" below, you will receive an email with a copy of your form responses. Print this email and mail it with your check to:

MVBT Membership
575 N. Shoreline Blvd
Mountain View, CA 94043

Please make your check payable to MV Buddhist Temple and write, "2021 Membership" on the memo line on your check.

(Note: These instructions will also be sent to you in the confirmation email)
Payment in Installments

After you click "submit" below, you will receive an email confirming your membership. Within a few days, you will receive a separate email that will provide you with further instructions on how to make your first payment.
- If you have chosen to pay in 2 installments, you will receive a reminder email in June with instructions on how to pay for your balance.
- If you have chosen to pay in 4 installments, you will receive reminder emails in April, July, and October.

Additional Notes/Comments for Membership Committee
Check Number
Postmark Date

Month Day Year
Date
SFDC Contact ID
Hidden
SFDC Account ID
Hidden
SFDC Member Level
Hidden
SFDC Membership Amount
Hidden
SFDC Paper Echo T/F
Hidden
sfdc Proxy TF
Hidden
Total Payment Calculation
Hidden
AR calc - Intro Text ALL EM
hidden
AR calc - Full Pay Para 2
hidden
AR calc - PayPlan Para 2 text
hidden
ARCalc - Today

Month Day Year
hidden
ARCalc - First payment due date

Month Day Year
hidden - calcuated field (today + 14)
ARCalc - Number of payments
hidden
ARCalc - First payment amount
hidden
Should be Empty:

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

MVBT Membership Categories beginning January 1, 2021

2021 MVBT Membership Form

Household Information

Household Members

Temple Directory

Toban Zone Preference

Payment Information

Payment Options:

Pay by Check

Payment in Installments