ANCIENT ROSAE CRUCIS MEMBERSHIP APPLICATION

Name:______________________________________________________________________
(Last) (first) (middle)
Address:____________________________________________________________________
City:__________________________St:_________Zip:____________Country:_____________
Date of Birth: (must be 18+years of age):______________________Gender:___________
Phone Number:_____________________________ E-mail: _________________________

Educational Level reached in school:___________________________________________
Occupation:_________________________________________________________________
Previous studies/affiliation with metaphysical/mystical/initiatic orders:
___________________________________________________________________________
___________________________________________________________________________
Why do you wish to unite with the Ancient Rosae Crucis, ARC?____________________
___________________________________________________________________________
___________________________________________________________________________
Do you accept the notion of one Supreme Being or God:________________

*****

To the Membership Committee, Ancient Rosae Crucis, ARC
P.O. Box 4764, Dallas, Texas 75208

I hereby accept your invitation to unite with the Ancient Rosae Crucis, ARC. If my application is accepted, I will abide by the following traditional pledge made by all Neophytes:

"I will keep confidential all reading matter and lessons sent to me and will endeavor to follow your program toward a life of greater understanding and attainment. I further state that all information on this application is correct and true."

__________________________________________________________________________
(signature required) (date)

Please remit Registration Fee and dues as listed below in U.S. dollars and send check or money order payable to ARC Funds. If you wish you may remit the reduced annual fee at this time. If for any reason your application is not accepted, your remittance will be refunded in full: At least one quarter's dues and registration fee must accompany application.

Amount remitted with this application:

• Registration Fee:__________
• Dues:__________________
• Total:___________________

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