CHAPEL OF AWARENESS

APPLICATION FOR GENERAL MEMBERSHIP

Please enter my name as a General Member of the
Chapel of Awareness Spiritual Church Corporation.

Name:_________________________________________
Address:_______________________________________
City: _____________________State:______ Zip:_______
Phone:______________ Date:________ Donation: $_____

560 Third Street, Encinitas, California 92024
www.chapelofawareness.org