Buddhist Recovery Network : Membership Subscription

If you have already registered with the BRN, click here to retrieve your registration details.

Please make sure to complete all fields marked with a red asterisk (*) as they are necessary to process your credit card payment.

Title:	First Name: *	Last Name: *
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ZIP/Post Code: *		State/Prov.: * US residents only
Country:	*


Phone: *		Email: *
		Confirm Email: *


Gender, are you		Anonymous Membership

To enable us to better understand our audience/members, we would be grateful if you could select the boxes below that best describe you. PLEASE FEEL FREE TO SELECT MORE THAN ONE BOX:
	Academic Researcher in the area of addiction and recovery
	Academic Researcher in the area of mindfulness
	Psychologist, psychotherapist or psychiatrist involved in addition and recovery
	Dharma Teacher
	‘Buddhist Recovery’ Retreat Facilitator
	Facilitator of a recovery group (‘Twelve Step’ related or other)
	In recovery within a Twelve Step context
	In recovery outside of a Twelve Step context
Other:


Comments/Special Instructions:
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Membership Type * (Please select one - all amounts in US$)	Individual Membership - regular: $50 or Student discount: $25 Professional Membership - $100 Organizational Membership - $200


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Before proceeding to the payment page, would you please ensure all data on this page is accurate. You will not have the opportunity to correct it once you proceed. All corrections must be requested by way of an email to paul at buddhistrecovery dot org.

Please click on this Register as a Member link to access our secure online payment facility.