Membership Directory Data Form

PLEASE READ THE FOLLOWING
To be included in the Order of Interbeing membership directory, and have access to the database, please complete the form below. The data collected will be available to other members of the Order of Interbeing only. Some fields may be hidden, if you choose, even to members of the Order of Interbeing. Use the check boxes on this form to identify information you wish to share with other members. All the data will be available to the site administrators and help us keep a current directory of all members. On occasion, the information will be used for Plum Village related mailings. If you have questions, please email directory@orderofinterbeing.org.

MEMBER INFORMATION
Email (check box to share) :		First Name:	List me as a Member on website?:	Checking this box means yes.
Middle Name:		Last Name:	True Name(s):
Address(check box to share):		City:	State/Province:
Zip:		Country:	Cell Phone (check box to share):
Home Phone (check box to share):		Work Phone (check box to share):
Fax:		Ordination Date:	Ordination Location:
Sangha:		Partner:
Region:		Leave Blank:	Alternate Email:
Dharma Name5:		Date5 Training:	Location5 Training:
Lamp Transmission Date :		Lamp Transmission Location:	Dharma Teacher	Selected means you have received Lamp Transmission.
Notes:
	Add me to OI-Community Email List