Center for Conscious Sustainable Living Membership Program and Interest Survey

The Center for Conscious Sustainable Living (CCSL) is a non-profit membership organization established to publish, produce and distribute educational programs, birthday messages, products and services that foster personal, community and planetary sustainability.

CCSL membership benefits include wicked broadway, a periodic newsletter with valuable information on personal, community and planetary sustainability, special discounts on most CCSL programs, featured products and services, special reports and other membership benefits.

___ I would like to become a CCSL member at: __$10 a month __ $20 a month __ $ ____ month

___ I would like to become a Lifetime Charter CCSL member for a one time donation of $1,000 or more _____

___ I would like my non-profit organization to be a member at __ $ 30 Month ___ $300 year

___ I would like my company to be a corporate member at __ $ 50 Month ___ $500 year

My primary areas of interest are:

___ Personal and community preparedness

___ Food Self-Sufficiency

__ Helping with marketing & promotion

___ Helping develop good night sms and implement a fundraising program __ Donating products/services to raise $

___ Fuel Self-sufficiency (such as a Community Supported Energy Cooperative)

___ Helping develop, fund and or utilize a Sustainable Learning Center/ Retreat Center

___ Investment opportunities in sustainability projects such as the greenhouse and fuel production

___ Other: _______________________________________________________________________

___ I am interested in attending CCSL programs on various aspects of conscious sustainable living;

__ Realizing My Ultimate Potential ___ Fulfilling My Life Purpose __ Enjoying Positive Loving Relationships;

__ Attaining Financial Freedom and Prosperity __ Enjoying Ultimate Health and Fitness

__ Achieving Ultimate Success in My Business/Career __ Raising My Consciousness Level

__ Enjoying Peace and Balance __ Harnessing My Creative Mind Power __Attaining Spiritual Enlightenment

__ Fostering Personal and Planetary Sustainability __Making A Difference and Leaving A Legacy. __Teaching programs on sustainable living on__________________________________________________ ___ Other: _______________________________________________________________________
Phone: ______________________ Email______________________________________ Address ______________________________ City ___________________ State ___ Zip ________ __ I am enclosing a check payable to CCSL for the items checked above for a total of $_______ __ Please send me an invoice for any amounts I have checked. __ I would like to use my good morning sms credit card . Please __ call me or __ email me to make arrangements. (Please print out and return your completed interest survey form to Center for Conscious Sustainable Living C/O Lily Hill Farm 32260 - 88th Avenue Lawton, Michigan 49065