Note: If you do not live in North America, please contact your local affiliated Zen Center or Regional Head Temple for membership information. These are listed on our Centers and Groups Page
First Name:
Last Name:
Address:
Address 2:
City:
State:
Zip Code:
E-mail address:
Your Phone Numbers (only if they've changed)
Work:
Home:
Cell:
Your Membership Number (if known) (3 to 5 digits):
Membership Dues: $
Dharma Teacher Dues: $
Other (please explain below): $
Total Contribution: $
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