Membership Registration Form 2015

Membership Registration Form
New (first time)
2015
Renewing
Last Name*
First Name*
Birth Date*
Address
City*
State/Province*
Zip/Postal*
Country*
Email*
Telephone*
Local Gar* or Ling: Tsegyalgar East
Kundroling NYC
Dondrubling CA
SELECT YOUR MEMBERSHIP TIER:
$260 Ordinary (25% off courses, one week free use of personal retreat cabins)
$600 Global Sustaining (50% off courses, two weeks free use of personal retreat cabins)
$1800 Global Meritorious (80% off courses, 50 days free use of personal retreat cabins)
Payment Information: We accept Checks, Cash, Visa and PayPal as forms of payment.
Checks and money orders can be made out to DCA.
Payment Options:
Monthly
Quarterly
In Full
Cash
PayPal
Check
Credit Card payments can be made through PayPal email address: [email protected]
(For Paypal Credit you must sign in and go to your paypal page before selecting Paypal Credit).
NEW: All Members enroll global ONLINE at: www.dzogchen.net
Signature
Date
Dzogchen Community in America - Tsegyalgar East • P.O. Box 479 Conway, Massachusetts • 01341 • U.S.A.
telephone: 413-369-4153
www.tsegyalgar.org