Membership Registration Form

Name*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number:*

Area CodePhone Number
What motivates you to become a member?

Healthy Living ProgramsYoga ProgramsDance ProgramsRetreatsEntertainmentGardening ConnectionsCommunity ConnectionsOther
Occupational Affiliations (Optional):
Special Skills (Optional):
By clicking the "Pay Now" button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, we will contact you about your Membership.

Thank you!
My Products
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Individual Membership$35.00

Quantity

Family Membership$45.00

Quantity

Supporting Membership$50.00

Quantity

Contributing Membership$100.00

Quantity

Sponsor$500.00

Quantity

Benefactor$1,000.00

Quantity
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty: