EmailMe Form - CLEAR WATER ZEN CENTER

Name *
First Last
Year of Birth *
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Home Phone *
### - ### - ####
Cell Phone
### - ### - ####
Email *
Emergency Contact *
First Last
Their Phone *
### - ### - ####
Married/Partnered?
Yes
No
Do you have a meditation practice of your own? If so, please describe
Do you have any physical limitations that might make sitting in meditation especially difficult? If yes, please describe
Membership suggests taking some responsibility for the financial viability of the Zen Center. Therefore we ask members to commit to making a regular financial contribution. If you are not able to donate at this time, please make note of that below. The amounts listed are those recommended.
PLEDGE DONATION *
$20.00 monthly
$60.00 Quarterly
$120.00 Semi-annually
$240.00 Annually
I’m unable to contribute at this time
Other Amount
The Clear Water Zen Center, 2476 Nursery Road, Clearwater, FL 33764, (727) 430-5002
THE CLEAR WATER ZEN MEDITATION GROUP, INC. is a 501(c)(3) charitable organization. All donations are tax deductible.