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Membership Renewal Form

       Please use this form to renew your subscription to the WPM.
       If your address and phone have not changed since you last subscribed, you do not need to fill in these      details, but please enter your e-mail.
       Many thanks for your continued support.

Last Name	*	*= Required field
First Name	*	*= Required field
Street address		Please fill these in if they have changed
City
State	US and Canada: Outside US & Canada, please type state or other administrative division:
ZIP code
Country
Phone
E-mail [Please enter twice - this is important]	* Please enter your e-mail again here *	Please type in your FULL e-mail address NO E-MAIL? Please type NONE in top box and your name in second box.
Date of renewal	*
SUBSCRIPTION DETAILS
Member level	*	See Subscriptions page for benefits.
Amount paid	*	Please enter the total amount paid including any donation.
Payment method *See below for instructions	Credit Card Check by post
PLEASE FOLLOW INSTRUCTIONS BELOW, THEN PRESS "SUBMIT FORM"
CREDIT CARDS
Credit card subscription is available from most developed countries plus Mexico, Brazil, Israel, South Afirca, South Korea, Hong Kong & Singapore.		Please go through the Paypal process, then come back here. This window will remain open. About Paypal
Difficulties with Paypal? Check out their US help or International Help. If your problem is not answered there, contact Paypal's Customer Service Department. If you think the problem relates to WPM pages, email us at paypalquery@pantheism.net
CHECKS ETC
US $dollar checks, money orders or international money orders	Please print this form and post it with your check to: World Pantheist Movement 131 North Ludlow Street, Suite 1311 Dayton, OH 45402-1111, United States	Printing problems? Check the troubleshooting page for answers.
UK £sterling checks	Please print this form, and post it with your check to: The World Pantheist Movement PO Box 18687 London NW3 2FG, United Kingdom
Please double check your entries, especially address and e-mail fields, and then:

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Contact us: wpm@pantheism.net

Membership Renewal Form

Please fill these in if they have changed

CREDIT CARDS

CHECKS ETC

Please
fill these in
if they have
changed