Dayton Pagan Coalition - Membership Application Form
Upon submitting the application form, a Paypal link will be provided for dues submission.

Yearly Membership dues for 2020 is $13.

Thank you for your support and we look forward to seeing you around! :)
Email address *
Applicant Name *
Street Address *
City *
State *
Zip *
Email *
Phone Number
If phone # provided, is it okay to leave a message?
Clear selection
Preferred Form of Contact *
Please note: we will still send emails as our primary method of contact.
We mail a regular newsletter to our members. Is it okay to send mail to the given address? *
Saying No may limit our ability to send you relevant newsletters and updates physically
I am interested in getting involved in the following DPC activities:
Acknowledgement of Eligibility *
By signing here I acknowledge that I am over the age of 18, a legal adult, and am willing to abide by the by-laws and policies of the Dayton Pagan Coalition.
Never submit passwords through Google Forms.
This form was created inside of Dayton Pagan Coalition.