Membership and Mailing List Form

Please print and send this form to Living Tao Foundation, P.O. Box 846, Urbana, Illinois, 61803 USA (You may need to adjust the size of your browser window to print this on one page.)

First name _____________ Middle name or initial _____________ Last name ___________________________________________

Street address_____________________________________________________

City_______________________ State/Province __________________________ Zip/Postal code _________

Country________________________

Phone (day) __________________ Phone (evening) ___________________ FAX _____________________

Email _______________________________ ___

Please put me on your mailing list only.

Payment information

Checks should be in U.S. dollars, drawn on a U.S. bank, and made payable to Living Tao foundation.

You can also use Visa, MasterCard/EuroCard, or American Express (no Euro-checks, please).

Active Member: $45 Supporting Member: $150 Patron: $500

I have enclosed a check (no Euro-checks, please) in the amount of _________________

Credit card (we accept Visa, MasterCard/EuroCard, and American Express) _______________

Name on card ____________________________

Card number _____________________________ Expiration date ______________

Amount _____________