Petition for Membership

“Let me respectfully remind you:
Life and death are of supreme importance.
Time swiftly passes by and opportunity is lost.
Each of us should strive to awaken. Awaken!
Take heed! Do not squander your life...”

Evening Gatha

Please fill out the following form to petition for membership in the Zen Center. We will never share your personal information with anyone, nor will completing this form result in spam email. (Fields marked with a * are required.)

Realizing that life and death are of vital importance, I hereby petition to become a member of the Great Plains Zen Center.

Full Name: *

Membership Level:

Practicing Member ($50 per month)

For those practicing with the Sangha on a regular, weekly basis. Practicing members receive a discount on sesshin and other events.

Affiliate Member ($30 per month)

For those who live at a greater distance from the regular sittings and who are unable to attend regularly.

Friend of GPZC (any amount per year)

For those who wish to support the Center and receive newsletters and special communications, but attend Center activities infrequently.

Address

Street Address: *

City: *

State: *

Zip Code: *

Phone Numbers

Home: *

Work:

Cell:

Email: *

Emergency Contact

Name: *

Relationship: *

Phone: *

Notes:

Please list any allergies, medications, conditions we should be aware of.

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Petition for Membership

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