Dharma Friend SignupMembership DetailsSelect who the membership is for*I am an individualI have a partner / familySelect your level of membership*Dharma Friend - $35 per monthVajra Friend - $50+ per monthDharma Friend Amount*If you would like to donate more than $35 per month, please edit the amount belowPlease enter a number greater than or equal to 35.Vajra Friend Amount*If you would like to donate more than $50 per month, please edit the amount abovePlease enter a number greater than or equal to 50.Select your level of membership*Dharma Friend - $50 per monthVajra Friend - $65+ per monthDharma Friend Amount*If you would like to donate more than $50 per month, please edit the amount belowPlease enter a number greater than or equal to 50.Vajra Friend Amount*If you would like to donate more than $65 per month, please edit the amount abovePlease enter a number greater than or equal to 65.Total Monthly Amount Price: $ 0.00 Personal DetailsName* First Last Partner / Family Names*Please enter the name of your partner or the names of your family membersEmail* Phone*Address*We need your address to send you a tax receipt! Tax receipts are posted at the end of the financial year. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Payment OptionsPayment Method*Automatic Monthly Payment from your bank account (Preferred)Monthly Payments via Paypal (PayPal account or Credit Card). (Please note Paypal take a percentage of each payment)Cash / Cheque (6 months or 1 year’s payment to be paid in advance)Automatic Monthly PaymentDCI’s bank account is as follows: Name: Dorje Chang Institute Bank: ANZ Account Number: 06-0589-0167320-00 Please mark auto-pay “Dharma Friend” + "your name" and notify us when payment has been set up.Monthly Payments via PayPalWhen you press ‘Submit’ below you will be taken to PayPal to setup monthly payments using either a PayPal account or a credit card. To use a credit card press the ‘Pay using your debit or credit card’ link at the bottom of the page.Cash / ChequeHow many months do you want to pay for?*6 Months12 MonthsCash / Cheque Amount Price: $ 0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.