MEMBERSHIP RENEWAL/APPLICATION

                            BHAVANA SOCIETY
                            Rt. 1 Box 218-3
                        High View, WV 26808 USA
               Tel: (304) 856-3241    Fax: (304) 856-2111
                                          
  
  I wish to enroll/extend as a member of the Bhavana Society, Inc. and 
  have enclosed $________for Standard Membership ($25.00); Life 
  Membership ($500.00); Patron ($1000.00)
  
  Name_________________________________________________________________
  
  Address:_____________________________________________________________
  
  _____________________________________________________________________
  
  City_____________________State_______Zip_________
  
  Home Tel  (_____)_____________________
  Office Tel(_____)_____________________
  
  Date______________________Signature____________________________________
  
  
  xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
  x                FOR BHAVANA SOCIETY OFFICE USE ONLY       DharmaNet x
  x                                                                    x
  x                                                                    x
  x Kind of Membership (Standard/Life/Patron) _________________________x
  x                                                                    x
  x Date of Membership__________________Date of expiration_____________x
  x                                                                    x
  x Membership No:___________________________________                  x
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