MEMBERSHIP RENEWAL/APPLICATION BHAVANA SOCIETY Rt. 1 Box 218-3 High View, WV 26808 USA Tel

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MEMBERSHIP RENEWAL/APPLICATION BHAVANA SOCIETY Rt. 1 Box 218-3 High View, WV 26808 USA Tel: (304) 856-3241 Fax: (304) 856-2111 I wish to enroll/extend as a member of the Bhavana Society, Inc. and have enclosed $________for Standard Membership ($25.00); Life Membership ($500.00); Patron ($1000.00) Name_________________________________________________________________ Address:_____________________________________________________________ _____________________________________________________________________ City_____________________State_______Zip_________ Home Tel (_____)_____________________ Office Tel(_____)_____________________ Date______________________Signature____________________________________ xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx x FOR BHAVANA SOCIETY OFFICE USE ONLY DharmaNet x x x x x x Kind of Membership (Standard/Life/Patron) _________________________x x x x Date of Membership__________________Date of expiration_____________x x x x Membership No:___________________________________ x xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

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