Dharma Field | Internet & Audio Mail-in Form

Dharma Field Internet Membership or Audio Subscription
Mail-in Registration Form

Type information into empty fields and click appropriate check boxes.

Name

Address

City State Zip

Daytime phone Evening phone

E-mail

	INTERNET MEMBERSHIP $150 per year Good through this date next year.
	AUDIO SUBSCRIPTION $50 per year Good through this date next year.
		Enclosed is an additional contribution of $ to help with expenses. (This contribution is 100% tax deductible.)
		Enclosed is an additional contribution of $ to the endowment fund. (This contribution is 100% tax deductible.)
	Total payment enclosed $

Membership dues and audio subscriptions are partially tax deductible and are not refundable.

Print this form and send with your check to:

Dharma Field
3118 W 49 St
Minneapolis MN 55410