The Academy for Spiritual and Consciousness Studies, Inc

 MEMBERSHIP APPLICATION

Date_____

Please enroll me as a member of The Academy for Spiritual and Consciousness Studies, Inc in the membership category marked below. Enclosed are my annual membership dues in the amount of $________ for the year beginning_____20_____.

__U.S. : $25.00      __Canada: $35.00     __International: $45.00

In addition to my annual dues, I'm enclosing a DONATION of $_____ to support the ongoing work and programs of the Academy.

 (Contributions to The Academy for Spiritual and Consciousness Studies, Inc.,   are deductible for income tax purposes under an Internal Revenue Service Section 501 (c) (3) ruling)

Name____________________________________ 

Address__________________________________

City_______________  State______   ZIP________

Telephone (      )___________________ 

E-mail Address ____________________

My present position, qualifications, and terminal degrees are as follows: (For completion by those applying for Academic Membership. Please attach biographical sheets, outlines of work accomplished, etc., if available.) Please consider submitting appropriate articles, papers, research proposals or abstracts for possible publication in The Journal for Spiritual and Consciousness Studies.

Please print, complete and mail this form with your check or money order made payable in U.S.A. funds to The Academy for Spiritual and Consciousness Studies, Inc and send to:

THE ACADEMY FOR SPIRITUAL AND CONSCIOUSNESS STUDIES, INC. 
P.O. Box 84 Loxahatchee, Florida 33470
U.S.A.

(516)714-1423       
pauljhauser@gmail.com

www.ascsi.org