The Temple of Nine Wells - ATC

Membership Form






Name: _____________________________________________________

Name (as you would like it to appear on card):

_____________________________________________________


Mailing Address:

__________________________________________________________

__________________________________________________________

__________________________________________________________

City ________________________________State_______Zip_________

Phone (Optional)____________________________________________

E-Mail (Optional)_____________________________________________

Annual Tithe $35.00
Additional Donation: $_____________
Total Enclosed $____________

Print out and mail with a Money Order to:

The Temple of Nine Wells - ATC
P.O.Box 281
Salem, MA 01970
978-745-8668
TNW-SALEM@TNW-SALEM.ORG