Divine Science Everywhere
Divine Science Federation International (DSFI)
110 Merchants Row / Suite 4
Rutland VT   05701
(802) 779 - 9019      (800) 644 - 9680

May Is Membership Month
We welcome your support and thank you for your participation !

INSTRUCTIONS
(1) Print this form.
You may either print it as a blank form and fill in the information by hand, or you may type in the information before printing.
(2) Mail check or money order with the completed form to the address above.

PLEASE NOTE!
We are not equipped to handle credit card payments over the phone or through the internet.

Name:
Street Address:
(more address):
City:
State/Prov:    Postal Code:
This is a NEW ADDRESS
Phone Number(s):
E-mail Address:
(Will Never be sold)
Church affiliation, if any:
 
I wish to: Join as a new member
Renew my annual membership
Give a gif of membership (fill in gift information below)
Make a donation
Membership Levels
  General Member     $   *
  Supporting Member     $100
  Sustaining Member     $250
  Life Member   $1,000
  * There is no set fee for General membership.
 
In addition to my membership/donation, I also wish to subscribe to At-One-Ment,
the bi-monthly daily devotional booklet for $15.00 (US) per year.
I also wish to give a gift subscription of At-One-Ment for $15.00 (US) per year
 
Enclosed is my check or money order in the total amount of:   $
   Do not send cash!

Again, your participation and support are much appreciated!

  GIFT of Membership     $
  GIFT of At-One-Ment     ($15 / year)


  GIFT FROM:     copy info from above
Name:
Street Address:
(more address):
City:
State/Prov:    Postal Code:
This is a NEW ADDRESS
Phone Number(s):
E-mail Address:
(Will Never be sold)
Church affiliation, if any:
 
  GIFT TO:
Name:
Street Address:
(more address):
City:
State/Prov:    Postal Code:
This is a NEW ADDRESS
Phone Number(s):
E-mail Address:
(Will Never be sold)
Church affiliation, if any:
 

Thank you for your generous gift !

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