Your Full Legal Name:

Your Email Address:

Your Phone Number:

The Name(s) Of Three Group Leaders (Nascents Will Indicate Only One Or Two):

The Name Of The City Or Town You Will Be Claiming As Your Home Base:

The Email Address You Wish To Make Your Group's Main Contact Address:

Are There Any Other Chapters Within Your Home Base Territory?

Yes No

The Name Of A Group Leader Who Lives Within 20 Miles Of Your Home Base:

The Home Base Leader's Street Address:

The Home Base Leader's City & State:

The Home Base Leader's Zip Code:

The Name Of Your Group's Chosen Pagan Charity:

The URL (If Any) Of Your Chosen Pagan Charity:

Membership Or Individual Sponsorship With This Charity Costs:
$ per (month/year)

PLEASE CONFIRM

This Charity Has Granted Permission To Be Listed As Your Chosen Pagan Charity

True False

This Charity Uses The Word "Pagan" Or A Similar Term When Describing Itself In Public

True False

This Charity Appears In Guidestar As A 501(c)(3) Charity (Required For U.S. Organizations)

True False

Your Group Will Tie Its Membership To Membership In This Chosen Pagan Charity

True False

All The Group Leaders Listed Above Are Already Members / Individual Sponsors Of This Charity

True False

Your Earthwise Gyre Group Will Not Charge Membership Dues Of Its Own

True False

Your Group Agrees To Abide By The Earthwise Gyre Mission And Policies

True False

Your Group Will Use Earthwise Gyre Channels For All Online Communications

True False

Your Group Will Host At Least One Member-Only Expedition Each Calendar Year

True False