Membership Request

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Membership Request

If you are interested in Northern Pagan Church membership please fill out this form to the best of your ability.

First and Last Name, Legal (Main Contact) *

Preferred Name (Main Contact)

Preferred Pronouns (Main Contact)

Date of Birth (Main Contact) *

YYYY

Address (Main Contact) *

Phone Number (Main Contact) *

E-mail (Main Contact) *

Please briefly describe the journey that brought you to Paganism or Northern Pagan Church. *

Please briefly describe your own personal beliefs regarding our relationship with the divine and/or nature. Are there any specific traditions you follow? Any specific deities you honor? *

Allergies, Sensitivities, and Dietary Concerns (Main Contact)

Partner's First and Last Legal Name (If Applicable)

Partner's Preferred Name (If Applicable)

Partner's Preferred Pronouns (If Applicable)

Partner's Date of Birth (If Applicable)

YYYY

Partner's Address (If Different from Main Contact)

Partner's Phone Number (If Applicable )

Partner's E-mail (If Applicable )

Please briefly describe the journey that brought your partner to Paganism or Northern Pagan Church. (If Applicable)

Please briefly describe your partner's personal beliefs regarding the our relationship with the divine and/or nature. Are there any specific traditions they follow? Any specific deities they honor? (If Applicable)

Partner's Allergies, Sensitivities, and Dietary Concerns
(If Applicable)

Children (If Applicable)

If you are comfortable please list their legal and preferred names, preferred pronouns, date of birth, and any allergies, sensitivities, or dietary concerns.

What skills and talents are you able to share with the NPC community? (and your partner, if applicable)

Emergency Contacts

Please list names, phone numbers, and relation of any emergency contacts you would like to have on file.

What is the start date of the Intro Class you attended, or the first date you began attending NPC events?

If you have been attending for a while approximate date will be sufficient.

YYYY

What info would you like included in the member directory? *

Please at least include your name (legal or preferred) and a phone number or email address. (Main Contact)

Legal Name (Main Contact)

Preferred Name (Main Contact)

Preferred Pronouns (Main Contact)

Address (Main Contact)

Phone Number (Main Contact)

E-mail (Main Contact)

Skills and Talents (Main Contact)

Partner's Legal Name (If Applicable)

Partner's Preferred Name (If Applicable)

Partner's Preferred Pronouns (If Applicable)

Partner's Address (If Applicable)

Partner's Phone Number (If Applicable)

Partner's E-mail (If Applicable)

Partner's Skills and Talents (If Applicable)

Number of Children (If Applicable)

Legal Name of Children (If Applicable)

Preferred Names of Children (If Applicable)

Preferred Pronouns of Children (If Applicable)

Allergies, Sensitivities, and Dietary Concerns within the family. (This can help other members try and plan inclusive food items)

Required

Would you like to subscribe to our e-mail newsletter?

Yes (Main Contact Only)

Yes (Main Contact and Partner)

Yes (Partner Only)

No (Already Subscribed)

No (I will stay up to date on events through other means)

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Are you able to agree to our membership agreement? *

I strive to root my path in Honor, Hospitality, and Sovereignty

I hold at my core a reverence for Nature and it's ever renewing cycle of Life, Growth, and Death

I recognize and respect the many branches that connect us with the Gods, Ancestors, and Spirits

I Agree to treat event attendees, members, and church leadership with respect and kindness, to resolve conflicts in a peaceful and respectful manner, and hold in confidence the identities and personal information of event attendee and membership.

Yes (Main Contact)

Yes (Main Contact and Partner)

No (I would like to speak to someone about an exception)

Comments/Questions

If you have any additional comments or questions please include them here.

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