Print this document out, sign it, and mail it or fax it back to us.

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Path of the Personal Divine Individual Membership Form
(this must be faxed or snail mailed back to us, signed)

I, ___________________________ , have read and understand the church's "Statement of Beliefs" and wish to express my commitment to the principles of inner growth and development, and the search for divine wisdom, by becoming a member of the church.

I accept personal responsibility for my own evolution on the Path and am willing to gain understanding of others' paths and live in harmony with those whose paths are dissimilar to my own.

Name:                                                     Age:

Date of Birth (if under 18)

Signature:                                             Date:

Signature of Guardian (if under 18)

********* All the below questions are optional! *****************

Craft name

Mailing address:


E-mail address:
Marital Status (single or partnered)
Children
Special skills or knowledge:

Special interests or hobbies:


What can the Path of the Personal Divine do for you?

Is there anything you feel the Path of the Personal Divine should become involved in?

What other organizations do you belong to?


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The Path of the Personal Divine, Pagan 
Panentheists: PO Box 8275, 
Lexington, KY 40533-8275.
http://home.earthlink.net/~PathPerDiv/index.htm
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