Pagan Directory Application

The Pagan Online Directory

Pagan Group / Coven name *As it should be in the Program
Address *As you wish it to appear on here
Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Do you want this address in the Directory? *
Yes No
Primary Phone *
Do you wish this phone # to be in the Directory? *
Yes No
Select type *
Secondary Phone
Select type
Email *
Fax # (if any)
Website URL

Briefly describe your group or coven tradition if any as it should appear in the Directory. *
Pagan Contact area: *How does interested pagans reach you?
Are you a Clergy?We are also beginning a Clery list, please add my name to it for a $5.00 one time fee.
Yes No Not right now
Clergy InformationClergy information as you wish it to be shown (your description of type of clergy and contact information)

All Payments:

Pagan Directory: *Please make your selection below knowing all that is given we thank you. Blessed Be.
$10.00 Pagan Directory $15.00 Pagan Directory plus Clergy
Agreement to terms. *Terms of $10.00 per year for this online Directory
Pagan Panel Group / Coven Signature *Please place the name of the responsible individual for your Group / Coven.
Date of Agreement *

Verification

Please enter any two digits with no spaces (Example: 12) *
This box is for spam protection - please leave it blank: