The Academy for Spiritual and Consciousness Studies, Inc

 MEMBERSHIP APPLICATION

Date_____

Please enroll me as a subscriber of ASCS Journal in the subscriber category marked below. Enclosed are the annual subscriber dues in the amount of $________ for the year beginning_____20_____.

__Library: $20     __Subscribing Agency: $15   

(If a outside the United States or Canada, add $20 per year for postage.  $7 extra per year if in Canada)

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 ____________________

 

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