Membership Form

Fort Collins
Shambhala Meditation Center

If you are interested in autowithdrawal of your dues, click here for a pdf file which you may print, fill out and mail.

First Name:	*
Last Name:	*
Mailing Address:	*
City:	*
State:	*	Zip: *
Telephone:	* (nnn-nnn-nnnn)
E-mail Address:	*

Member of the Center Yes, I would like to be a member and donate Please see direct deposit form.	Amount
Member of the Center Yes, I would like to be a member and make arrangements for less than $ 25 per month.	Amount
Friend of the Center Yes, I would like to be a Friend of the Center and donate $30 per year for a newsletter subscription.	Amount

Dues and donations are tax deductible. Please make checks payable to FCSMC

Mailing address:
Fort Collins Shambhala Meditation Center
C/O Kathe Mehlbach
4602 Morning Dove Court #5
Fort Collins, CO 80521

Comments:

Learn more about meditation and buddhism at shambhala.org

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Fort Collins Shambhala Center
(mailing:PO Box 1336, Ft. C. 80522) 126A W. Mountain Ave., Fort Collins, CO 80524
Tel. 970 482 4460 Email: infofcsmc@fc-smc.org

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