PeaceWorks North America News & Info

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Becoming A Member

  Email Address:  

  Last Name:      

  First Name:     

  Address:        
                  Please enter your entire address as one long line

  Telephone:      

  Dance Circle:   
                  Please let us know where you regularly attend the Dances

  Membership:     Lifetime Memberships
                     COUPLE - $3000 one time
                     INDIVIDUAL - $2000 one time
                  Yearly Memberships
                     BENEFACTOR - $500/year
                     FRIEND - $100/year
                     COUPLE - $90/year
                     ASSOCIATE - $90/year
                     REGULAR - $60/year
                     LOW INCOME - $40/year

  Payment Method:  Personal Check
                   Money Order
                   Mastercard
                   Visa

  Credit Card #:    Expires: 
                  If you don't feel comfortable sending your credit
                  card info over the net, enter "I'll call you" for
                  the card number and then call us at 760-922-2551

  Name on Card:   
                  Exactly as it appears on your credit card

  Comments:       

  Mail Options:    Do not mail printed journals
                   Email membership directory (350k PDF file)
                   Do not mail occasional announcements
                   Do not email occasional announcements

  Membership Directory Listing Options:
     Listing:      List me in the membership directory
                   Do not list me in the membership directory at all

     Email:        List the email address I entered above in the membership directory
                   List this email in the directory instead: 
                   List no email address in the membership directory

     Phone:        List the telephone I entered above in the membership directory
                   List this phone in the directory instead: 
                   List no telephone in the membership directory

     Address:      List the street address I entered above in the membership directory
                   List no street address in the membership directory

  Additional Listing Options for Dance Network Contacts and Leaders:
     Listing:      List me on the NA website
                   Do not list me on the NA website at all

     Web Email:    Use the email address I entered above for NA website
                   Use this email for NA website instead: 
                   Use no email address on NA website

     Web Phone:    Use the telephone I entered above for NA website
                   Use this phone for NA website instead: 
                   Use no phone on NA website