Membership Application


Become a Dignity Member

Become a member of Dignity and let your voice be heard.  Dues for membership are listed below.  Please print this form on your computer and mail to the address below.


Please fill out the following infomation:




State_______________Zip Code________________________

E-Mail Address______________________________________

Check one of the membership levels below:

(   ) Single Membership ($50.00)

(   ) Archangel ($250.00)

(   ) Angel of Light ($500.00)

(   ) Angel of Faith ($1,000.00)

(   ) Angel of Love ($5,000.00)

(   ) I wish to be a member but cannot contribute at this time

Signature: X

Make contribution check payable to:
  Dignity USA Inc.
  P.O. Box #376
  Medford, MA 02155

Please Note: Membership expires after 12 months unless the member renews.