"Benefactor" Membership Application

Your first name:

Your last name:

Your email:

Your telephone number:

Your address (please include postcode):

Your birthday:
Day:
—Please choose an option—12345678910111213141516171819202122232425262728293031
Month:
—Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
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Are you already an existing member of Atisha Centre or are you applying to become a new member?
Existing MemberNew Member
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I would like to apply for:
Single Benefactor MembershipFamily Benefactor Membership

Family Memberships only ~
Please list the names of family members to be linked to your membership:

I have the following skills and may be interested in volunteering at the Centre:

AdministrationLegalBuilding/MaintenanceRetail/BusinessCateringGardeningEducationComputer/TechnicalPublicationCleaning

~ Other (please specify):

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Do you wish to apply to be a voting Member at the Atisha Centre AGM?

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If you answered "yes" to applying to be a voting Member, you are required to supply 2 referees who must be current Members of Atisha Centre:

REFEREE No.1 - Name + Phone or Email:

REFEREE No.2 - Name + Phone or Email:

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* I declare that I am committed to the vision, values and goals of Atisha Centre and the FPMT and the Spiritual Director, Kyabje Lama Thubten Zopa Rinpoche.
* I adopt the attitude of universal responsibility as taught by His Holiness the Dalai Lama and accept and understand Atisha Centre's affiliation with FPMT.
* I do not practise Shugden. (If you do not know what this is, you can safely tick the box).

***Click to accept this understanding:
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