Mother Earth Sensory Attraction Society
(MESA)
APPLICATION FORM
Instructions: Cut and Paste (copy)
this application form for emailing. Although Course enrollement may be
immediate, please allow 7-14 days to receive the final course date assignment
schedule and participants list.
Applicant: Please email this
application. Also send a hard copy of it along with a check, payable to
Institute of Global Eduction, for your recommended $ 40.00 contribution.
TO: MESA
Institute of Global Education
P. O. Box 1605
Friday Harbor, WA 98250
888-285-4694
I am familiar with the description and
purpose of MESA and am applying
for membership and required enrollment in the Program and Orientation Course
entitled: Psychological Elements of Global Citizenship.
Name
Email Address
Website URL if applicable
Postal Address
City, State, Zip
Telephone
Occupation or major interest:
The course starts at the beginning and middle
of each month or by convenient dates for 4 or more participants and a facilitator.
Participants may be located in any part of the world, from any ecosystem,
nation or school.
Preferred dates to take course: during the week
commencing Sunday:
First Choice:
Second Choice:
Third Choice:
Will you be doing the course ( ) with or ( ) without
the use of the book "ReconnectingWith
Nature"?
Are you presently interested in continuing on
with the Introductory
course ( 1 credit optional) ? ( ) yes ( )no
Introductory Statement: please enclose one or two paragraphs about your background
and why you want MESA membership and to take the course. Please
retain a copy
of this statement as you can use to introduce yourself to your e-mail classmates.
You may modify it for that purpose if you choose.
NOTE: A prerequsite for this course is required. If
you have not fulfilled it, do it now while you are waiting for the course
to start.
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