Earth Spirit Pagans - Membership form

Please complete the form below and mail it with your check or money order to: 

Earth Spirit Pagans
c/o C. West
721 N. Hancock Ave.
Colorado Springs, CO 80903

Your check acts a your receipt.

Thank you for your support.
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Membership form for Earth Spirit Pagans


Name:_________________________________________________________________


Address:________________________________________________________________


City:_________________________________ State:__________ Zip Code:__________


Phone: ( )_________________________Email address:________________________________

*(Family-$30, Individual-$20, Student-$15 (with a copy of valid student ID)

If you are joining as a family, please list the names of the family members here: 

  _______________________________________________________________________ 


*Total Membership Dues $___________________(USD)


 _____________________________________________________________________ 
Signature                                                         Date 
  (Persons under the age of 18 years must have the signature of a parent or guardian) 


_____________________________________________________________________ 
Parent or Guardian signature                                      Date 

Revised 6-10 


Earth Spirit Pagans...A World of Difference