Membership Form

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Meditation Instructor
We encourage each member to establish an ongoing working relationship with the meditation instructor (MI) of her/his choice. If possible, enter the name of the MI you are working with or would like to work with. (To learn about working with an MI see Meditation.)
Volunteer Interests*
Please select the way(s) you would like to contribute as a volunteer. (To learn about volunteer opportunities see Volunteering.)
- Centre Environment Team
- Ikebana Group
- Public Meditation Staff
- Way of Shambhala Course Staff
- Shambhala Training Weekend Retreat Staff
- Dorje Kasung
- Victoria Shambhala Council
- Other (please specify in Notes below)
Membership Dues*
Please select how often you would like to pay dues, and enter the amount in the corresponding field that appears. The preferred method of payment is monthly automatic debit withdrawal. All dues are tax-deductible. (To learn about dues see Membership Dues.)
- Monthly
- One time
- Other (please specify in Notes below)
Monthly Membership Dues*
Please enter the amount ($) you would like to give monthly.
One-Time Membership Dues*
Please enter the amount ($) you would like to give one time.
Notes
You may enter any additional notes here.
Privacy*
- By using this form you agree with the storage and handling of your data by this website.