Mail-in Membership Application
You do not need to fill out this form if you apply online
on the "Membership" page of this website.
If you choose not to apply online:
print this page by right clicking and printing, fill
out the information on the form below and send this form
along with your personal check or money order to:
- National Ayurvedic
Medical Association
- 620 Cabrillo Avenue
Santa Cruz, CA 95065
Application for Membership
Name
____________________________________________________________
Organization
____________________________________________________________
Address
____________________________________________________________
City, State,
Zip
____________________________________________________________
Phone
Day
____________________________________________________________
Phone
Eve
____________________________________________________________
Fax
____________________________________________________________
E-mail address
____________________________________________________________
Date
of Application ____________________________________________________________
TYPE OF MEMBERSHIP:
[
] General Membership
$ 50.00 /yr
[
] Student Membership
$ 25.00 /yr
full time student with ID card or letter from school
[
] Practitioner Membership
$ 150.00 /yr
a professional practitioner of Ayurveda
(Please use
separate application form)
[
] Lifetime General Membership
$ 500.00
[
] Benefactor Member
for those wishing to support Ayurveda and NAMA at the following
level
Bronze
$ 100.00
Silver
$ 500.00
Gold
$1,000.00
Platinum
$5,000.00
PAYMENT:
[
] Check
or money order
____________________________________________________
[ ]
Visa or [
] Master
Card # ____________________________________________________
Expiration
Date:
____________________________________________________
Name on card:
____________________________________________________
Signed
____________________________________________________
Dated
____________________________________________________
It is a policy of NAMA to give, sell or trade our
mailing list to other Ayurvedic resource groups.
[
] Check this box
to stop sharing your name, but continue to receive NAMA
correspondence.
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