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Join Our Sacred Community

Begin Your Journey into Ancient Wisdom and Sacred Plant Medicines

Sacred Membership Application

Complete this application to join the Per Ankh Entheogenic Church community. All information will be kept confidential and used only for membership processing.

Personal Information

Name *

Email *

Phone

Ex: (201) 555-0123

Address

Date Of Birth

ARE YOU AN EMPLOYEE OR CONTRACTOR WITH ANY STATE OR FEDERAL ENFORCEMENT AGENCY? *

Yes No

DO YOU SEE MUSHROOMS AS PART OF YOUR SPIRITUAL PRACTICE? *

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 1 file. 2 MB max

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 THIS CHURCH? *

PER ANKH ENTHEOGENIC CHURCH

15605 Woodrow Wilson
Detroit, Michigan 48238

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