[SLG logo]Welcome to
Shining Lakes Grove, ADF

Shining Lakes Grove, ADF
P.O. Box 3901, Ann Arbor, MI 48106
(734) 277-1897

Membership Form

One form per person, please.

Legal Name: ________________________________________________  P C


Religious Name (optional):__________________________________  P C


Address: ___________________________________________________  P C


City: __________________________________  State: ___________  P C


ZIP Code: ______________  Phone: ___________________________  P C


E-Mail Address: _________________ P C  Birthdate: __________  P C

In the column next to your personal information, please indicate whether the information is Publishable (P), or Confidential (C). Publishable information will be printed in the annual Membership Directory. Confidential information will only be shared with members of the Leadership Council.


Please check one of the following:

___ New Membership
___ Revival of expired membership
___ Renewal of current membership
___ Name/address change (prior name/zip) _____________________________________


SLG Adult Membership and Donation Categories:

SLG Local Membership*                   ___ years at $24 = $ ______


SLG General Fund donation                                  $ ______


SLG Land Fund donation                                     $ ______


  Total enclosed                                           $ ______

*Note: to be a full member of Shining Lakes Grove you must also join ADF. Only full members are eligible to hold office and vote. For ADF membership, see the ADF web site.


SLG Child Members (aged 1-6 years):

SLG Child Members must have at least one parent/legal guardian who is a member of SLG.

Name(s) of member parent(s)/guardian(s): ________________________________________

___ SLG Child Membership, New                         $6 = $ ______



___ SLG Child Membership renewal (free)


SLG Junior Members (7-12 years old):

SLG Junior Members must have at least one parent/legal guardian who is a member of SLG.

Name(s) of member parent(s)/guardian(s): ________________________________________

SLG Junior Membership                    ___ years at $6 = $ ______


SLG Youth Members (13-17 years old):

SLG Junior Members must have at least one parent/legal guardian who is a member of SLG, or have notarized permission from a parent or guardian.

Name(s) of member parent(s)/guardian(s): ________________________________________

SLG Youth Membership                    ___ years at $12 = $ ______


                                           TOTAL ENCLOSED  $ ______


Waiver: Required for Youth Members who have no member parent/guardian.

To whom it may concern:  __________________________________ has my

                             (enter child's name here)

permission to become a member of Shining Lakes Grove, ADF, and I am

fully aware of the neopagan nature of this organization.


Parent's Signature      __________________________________________


Parent's Name (printed) __________________________________________


Notary Signature        __________________________________________


License and Expiration  __________________________________________


Date Signed             __________________________________________