This application must be printed and sent by regular mail. 

MEMBERSHIP APPLICATION

Would you consider joining us in the pursuit to end abuse in the Christian home?

o         Yes, I would like to become a one-year member of PASCH, and receive all newsletters for one year. Enclosed is my $25 check.

o         Yes, I would like to become a one-year member of PASCH, and receive all newsletters for one year. I am requesting the low-income rate. Enclosed is my $15 check.

o         Yes, I would like to become a three-year member of PASCH, and receive all newsletters for three years. Enclosed is my $64 check.

Please send my membership newsletters as :

o        Email

o        Hard copy

o        Yes, I would like to make a one-time, tax ­deductible contribution to PASCH. At this time I am not  interested in becoming a member.

Please print the following information:

Name:  ______________________________________________________________________________________

              First                                                      Middle                                                       Last      

Company/ Organization:

Mailing Address ___________________________________________________

                         ________________________________________________________

Phone: ____________________________

Email: ___________________________________

Please make checks payable to and send with your membership application to:

Peace and Safety in the Christian Home

1095 Stony Brook Road

Brewster, MA 02631-2448