Membership Form

Salt Lake Interfaith Roundtable Registration Form. Mail completed form to Salt Lake Interfaith Roundtable, 9859 Dream Circle, South Jordan, UT 84095 or E-mail to info@interfaithrountable.net
The Regular membership fee is $25, $10 for college students with a student ID] and $100 for an organization allowing for 2 representatives to attend. Payment can be made by Clicking the link in the Membership page to pay using PayPal ; or pay by check/money order made out to: Salt Lake Interfaith Roundtable and mail to: 9859 Dream Circle, South Jordan, UT 84095. [Please include the purpose of the payment as “Membership fee.” ]

Completion of this registration form indicates that you allow Salt Lake Interfaith Roundtable to use any photos and/or video footage of yourself as well as any presentation materials that you present. By providing information requested below you agree that the Salt Lake Interfaith Roundtable may use it on their website. After filling the entries, please read and sign below that you are in agreement with the purposes of the Salt Lake Interfaith Roundtable.
I understand that the purpose of the Salt Lake Interfaith Roundtable is to bring greater love, harmony and understanding to our community. I affirm that I (and any organization I represent) agree to participate in the Roundtable in an attitude of seeking harmony, gaining greater understanding and acquiring an increased sense of love for and collaboration with all of the listed faith traditions and interfaith organizations. I (and any organization I represent) also understand that all members and organizations of the Salt Lake Interfaith Roundtable are committed to the position of being life affirming, community building faiths, organizations, and individuals.(Note: “Faith” includes a “Culture or Belief System.”)

Gender: o M o F

Membership Type: o Representative o Individual o Student ext

Full Name: Please list below the names according to how you wish to be called, and listed on your name badge. Your name badge will include your Title (if listed), First Name, Last Name, Position and Organization. (3 lines of no more than 27 characters per line.) (Title: Rev., Rabbi, Dr., etc.) First Name, Last (Family) NameParagraph

Position:

Organization:

Mailing Address: o Home o Office (Please check if home or office address)

Street Address or P.O. Box

City

State

Zip Code

Phone

Please explain how you would like to support the activities of the Roundtable: e.g., Interfaith month committee, event organization, service projects, and/or newsletter articles.

Paypal payments can be made by going to URL https://www.paypal.com/donate/?hosted_button_id=ZSW4YC3R8AZG4

AMOUNT Paid:_______________ Fee paid by: o Cash o PayPal o Check #_________________

Students state name of school

Signature:

Payment

Date [mm/dd/year]

If you are human, leave this field blank.

Membership Form

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