Please complete the form below, then submit your donation.

  1. I request to affiliate with the Sacred Well Congregation.

  2. I have read and endorse The Five Tenets of the Sacred Well Congregation.

  3. I understand that my affiliation with The Sacred Well Congregation of Texas is voluntary and without obligation or condition of any nature other than to endorse and affirm in faith and practice The Five Tenets.

  4. I understand that I may terminate my affiliation with the Sacred Well Congregation of Texas at any time simply by written request. I further understand that my membership may be terminated for cause (willful violation of The Five Tenets) by action of the International Executive Council.

PRIVACY NOTICE AND CONFIDENTIALITY: All personal information will be held in strictest confidence and will not be released outside of the Sacred Well Congregation without your expressed written consent. Demographic information will be used for administrative and statistical purposes only and will not be released outside the Congregation in any form that would identify you as an individual. Items marked with an asterisk (*) are Manditory.

Membership Application

Organization:
*First Name:
Middle Initial:
*Last Name:
*Address:
Address 2:
*City:
*State:
*Zip:
Country:
Home Telephone:
*E-Mail:
URL:
Names of Additional Members:
Which Membership Are You Interested In?
Comments:
Upon clicking the "submit" button, you will be redirected to our tuition payment page.