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! :)
* Required
Email address
*
Your email
Applicant Name
*
Your answer
Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip
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Your answer
Email
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Your answer
Phone Number
Your answer
If phone # provided, is it okay to leave a message?
Yes
No
Clear selection
Preferred Form of Contact
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Please note: we will still send emails as our primary method of contact.
Email
Phone
Mail
Required
We mail a regular newsletter to our members. Is it okay to send mail to the given address?
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Saying No may limit our ability to send you relevant newsletters and updates physically
Yes
No
I am interested in getting involved in the following DPC activities:
Social Events / Themed Gatherings
Classes
Psychic Fairs
Dayton Pagan Pride Day
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.
I agree
Required
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