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Petition for Membership

“Let me respectfully remind you:
Life and death are of supreme importance.
Time swiftly passes by and opportunity is lost.
Each of us should strive to awaken, awaken,
Take heed, do not squander your life...”

Evening Gatha



Please fill out the following form to petition for membership in the Zen Center. We will never share your personal information with anyone, nor will completing this form result in spam email. (Your name and membership level are required. Other required fields are in bold.)

Realizing that life and death are of vital importance, I, , hereby petition to become a (choose one):

Practicing Member ($50 per month)

(For those practicing with the Sangha on a regular, weekly basis. Practicing members receive a discount on sesshins.)

Affiliate member ($30 per month)

(For those who live at a greater distance from the regular sittings in Palatine and who are unable to attend regularly.)

Friend of GPZC (Pledge any amount per year)

(For those who wish to support the Center and receive newsletters and special communications, but attend Center activities infrequently.)

of the Great Plains Zen Center.

Street Address:

City:

State:

Zip Code:

Phone (with area code):

Home:

Work:

Cell:

Email Address:

Emergency Contact:

Name:

Relationship:

Phone (with area code):

Please list any allergies, medications, conditions we should be aware of: