Membership Application Form

"I am of the opinion that my life belongs to the whole community, and as long as I live it is my privilege to do for it whatever I can. I want to be thoroughly used up when I die, for the harder I work the more I live. I rejoice in life for its own sake. Life is no “brief candle” for me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations." George Bernard Shaw

Membership

Personal Information

Name*
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Preferred User Name
Email Address*
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Telephone
Address
Zip or Post Code
Languages Spoken
Gender
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Interests Interests (Please tick all that apply)

Agriculture	Economics	Mythology
Altered States	Education	Neuroscience
Anthropology	Ethnobotany	Philosophy
Archaeology	Genetics	Physics
Art	Healing	Poetry
Astronomy	History	Politics
Chemistry	Kundalini	Programming
Classics	Linguistics	Psychotherapy
Comparative Religion	Martial Arts	Psychology
Consciousness	Mathematics	Shamanism
Creativity	Medicine	Strategic Thinking
Divination	Meditation	Writing
Drama	Music	Yoga

Other interests and any more detailed information you would like to add regarding your interests

Qualifications and experience

If you would like to offer your help, please tick.

Mentor	Consultant	Speaker
Research	Other

Any additional comments or information

“The most beautiful thing we can experience is the mysterious. It is the source of all true art and science.”

- Albert Einstein