PER ANKH ENTHEOGENIC CHURCH
Become a Member
Religious Evolution
Ethos & Structure
ceremony and safety
Events
Contact
Become a Member
Apply to Join The Church
Become A member of Per-Ankh House of Light Entheogenic Church
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Phone
*
Address
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Date Of Birth
mm/dd/yyy
Do you work for government or any government agency?
*
Yes
No
DO YOU ACCEPT ENTHEOGENIC PLANTS (INCLUDING CANNABIS AND MUSHROOMS) AS PART OF YOUR RELIGION?
*
Yes
No
DO YOU AGREE TO FOLLOW THE RULES AND REGULATIONS OF THE CHURCH?
*
Yes
No
DO YOU SMOKE, CONSUME, OR USE CANNABIS IN ANY WAY?
*
Yes
No
DO YOU SUPPORT THE PRIVATE ADULT USE OF ENTHEOGENIC PLANTS? *
*
Yes
No
DO YOU THINK ADULTS SHOULD HAVE A SAFE PLACE TO USE AND/OR ACQUIRE ENTHEOGENIC PLANTS?
*
Yes
No
Upload your ID
*
Click or drag files to this area to upload.
You can upload up to 2 files.
Upload a Valid ID both Front and Back
WHO WERE YOU REFERRED BY (NAME & MEMBER NUMBER)? OR WHERE DID YOU HEAR ABOUT PER ANKH CHURCH?
*
WHY DO YOU WANT TO JOIN THE CHURCH?
*
Submit
