CIMC - Membership Form

CIMC Membership Form

Please fill out this CIMC Membership Form completely. If there is an asterisk next to a field it is required. Thank you.

Visually impaired?

If you are unable to read this form, please call the center and and we will be happy to process your membership over the phone. 617-441-9038

First Name *
Last Name *
Street Address *
City *
State *
Zip-code *
E-mail Your email is only used in order for the center to communicate with you. We never give out your email address.
Primary or Home Phone *
Secondary or Daytime phone
Occupation

Pledging

Becoming a member of CIMC is a way of expressing a commitment to the Center and making a contribution to its ongoing work. Members support CIMC through their annual pledges. Without this source of income, CIMC could not continue to exist as a center for teaching and practice. This contribution is is fully tax-deductible.

The CIMC membership year is the same as the calendar year (Jan-Dec) for everyone. We ask that renewals be made in January if possible. The suggested annual pledge is $300, or $25 a month. However, we recognize that $300 is not appropriate for everyone: for some it is too high, and for others too low. Therefore, we have included other options: one is to pledge $420 annually, ($35 a month) and another is to pledge a different amount that you feel is most appropriate for your income.

You can fulfill your pledge in monthly installments, 2 installments (semi-annual), 4 installments (quarterly), or all at once if you like. Your pledge of support in any amount is greatly appreciated.

You may join at any time during the year. To make a membership pledge for part of a year, just determine how much you are comfortable pledging each month, and multiply it by the number of months remaining in the calendar year.

For example, to join at the suggested pledge amount of $300 annually or $25 a month from March through December, your pledge would be 10 x $25 or $250.

If you have questions or concerns about payment, or if you would like information about work exchange or financial aid, please call the office at (617) 441-9038.

My total pledge amount for 2010 or for the remainder of this calendar year is: The total amount you wish to pledge for the rest of the year
My intention is to pay my pledge in this way: *
I prefer to receive communication by email if possibleYesNo - use U.S. mailNot sure
I would like my name, address, and phone, listed in the membership directory (given only to other members)YesNo
I would like to help at the center. I am interested in: Wednesday evening greeting Gardening Cooking for retreats Helping in the office Tape transcription Flower yogi, (creating simple flower arrangements for the meditation hall and the center, in turn with other volunteers) I can offer other skills, please contact me.

Release form

Membership and participation in the activities at the Cambridge Insight Meditation Center are entirely voluntary. The Center is not responsible for any personal injuries or any other harm sustained by you while on the premises. All activities at the Center, including retreats, interviews and volunteer work, are entirely at your own discretion. If you have any concerns about your ability to safely participate in or complete any activity, please speak to the Center staff. Please enter your initials below acknowledging that you accept these limitations of the Center's responsibility and are aware of the voluntary nature of all activities.

Please read the release form and then write your initials in this box. *
In case of emergency please contact: * Name and phone of a person to contact in an emergency