Red Hills Pagan Council Membership Form                                     P.O. Box 15311  Tallahassee, FL 32317-5311            

Print this form

Beside your name, address, phone and email address, please indicate whether the information is: Publishable (P), meaning it can be posted on the RHPC website and publications for people who might wish to contact you; Sharable(S) meaning we can share it with other RHPC members only; or Confidential (C) meaning that only RHPC officers will know it.
Secular Name________________________________________________( )P   ()S   ()C
Religious Name_______________________________________________( )P   ()S   ()C
Address:____________________________________________________( )P   ()S   ()C
   City:__________________________________________State/Provence:______________
   Zip/Post Code:___________________                 Country:__________________________
Phone: (___)_____________( )P   ()S   ()C              Birthdate:____/____/____( )P   ()S   ()C
Email Address:__________________
  • Are you a member of a coven, grove, or group? If so, which one?_______________________
  • The information on this form represents a: ()New membership ()Renewal  () Revival of Expired Membership
  • If this is a new membership, where did you hear about us?___________________________


RHPC Membership Rates:

Individual_____ year(s) @ $5 = $_______   Family _____ year(s) @ $10 = $_______

Additional donations to the RHPC General Fund $_______
                                           Total Enclosed: $_______

Checks or money orders should be made payable to “RHPC” in US Dollars only, and mailed to:    RHPC         P.O. Box 15311       Tallahassee, FL 32317-5311


I certify that I am 18 years of age or older: () Yes   () No (Check one)

Waiver

If you are under the age of 18, you must have a parent or guardian sign here to indicate his/her permission for you to be a member of RHPC, and that signature must be notarized.

To whom it may concern:____________________ has my permission to become a member of the Red Hills Pagan Council and I am fully aware of the Neo-pagan nature of this organization.

__________________________________________Parent or Guardian’s signed name

__________________________________________Parent or Guardian’s printed name

Notary Seal