Confraternity of the Rose Cross
 

Printable copy (.pdf )

APPLICATION FOR MEMBERSHIP
(Review)
(to print this application click on "Printable copy" on the right)

Confraternity of the Rose Cross
PO Box 304
Tillson,  NY  12486-0304
USA


NAME:  ____________________________________________________________________
ADDRESS:  _________________________________________________________________
CITY: _______________________________  STATE: __________  ZIP CODE: ___________
PHONE: (        )___________________  E-MAIL ADDRESS: __________________________
COUNTRY OF CITIZENSHIP: ___________________________________________________
DATE OF BIRTH:  __________________________________   GENDER(M/F): ___________
OCCUPATION:  ______________________________________________________________
EDUCATION: ________________________________________________________________
____________________________________________________________________________

MYSTICAL/ FRATERNAL ORGANIZATIONS IN WHICH YOU ARE CURRENTLY A
MEMBER:____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

MYSTICAL/ FRATERNAL ORGANIZATIONS IN WHICH YOU WERE A MEMBER IN THE PAST:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

WILL YOU KEEP AN OPEN MIND AND FAITHFULLY STUDY THE ROSICRUCIAN TEACHINGS
AND APPLY THEM IN YOUR DAILY LIFE? _________________________

WHY DO YOU WISH TO BE A MEMBER? _______________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

         SIGNED: _______________________________     DATE: _____________________

 

REGISTRATION & DUES:

  For USA, Canada and South America:

ENCLOSED:

REGISTRATION FEE:                                                   $25.00US    __________
(per member, payable with application*)

CR+C ANNUAL MEMBERSHIP DUES                           $100.00US   __________
(payable in quarterly installments of $25.
Regist. fee + 1st Qtr Pmt required with application)

CR+C ANNUAL COMPANION MEMBERSHIP DUES      $140.00US   __________
(For two members of the family - same mailing
address. Payable in quarterly installments of $35)

                                               TOTAL AMOUNT ENCLOSED*:         __________

* Regist. fee + 1st Qtr Pmt required with application.
Min $50.00US single or $85.00US companion.

*If application is not accepted, registration fee will be refunded

 For United Kingdom:

ENCLOSED:

REGISTRATION FEE:                                                   £16.25    _______ 
(per member, payable with application*)           

CR+C ANNUAL MEMBERSHIP DUES                            £65.00   __________
(payable in quarterly installments of £16.25
1st Qtr Pmt required with application)

CR+C ANNUAL COMPANION MEMBERSHIP DUES       £92.00   __________
(For two members of the family - same mailing
address. Payable in quarterly installments of £23.00
Regist. fee + 1st Qtr Pmt required with application)

                                             TOTAL AMOUNT ENCLOSED*:      ___________

* Regist. fee + 1st Qtr Pmt required with application.
Min £32.50 single or £39.25 companion.

*If application is not accepted, registration fee will be refunded

 For Australia, Singapore, Philippines/Australasian region, India:

ENCLOSED:

(outside Australia)
REGISTRATION FEE                                                  $45.00AUS    __________
(per member, payable with application*)

CR+C ANNUAL MEMBERSHIP DUES                         $180.00AUS   __________
(payable in quarterly installments of $45AUS
Regist. fee + 1st Qtr Pmt required with application)

CR+C ANNUAL COMPANION MEMBERSHIP DUES    $220.00AUS  __________
(For two members of the family - same mailing
address. Payable in quarterly installments of $55AUS
Regist. fee + 1st Qtr Pmt required with application)

(in Australia)
REGISTRATION FEE:                                                 $35.00AUS    __________
(per member, payable with application*)

CR+C ANNUAL MEMBERSHIP DUES                         $140.00AUS   __________
(payable in quarterly installments of $35AUS
Regist. fee + 1st Qtr Pmt required with application)

CR+C ANNUAL COMPANION MEMBERSHIP DUES    $180.00AUS  __________
(For two members of the family - same mailing
address. Payable in quarterly installments of $45AUS
Regist. fee + 1st Qtr Pmt required with application)


                                                   TOTAL AMOUNT ENCLOSED*:     __________

* Regist. fee + 1st Qtr Pmt required with application.
Outside Australia Min $90 single or $145 companion.
Inside Australia Min $70 single or $115 companion.

*If application is not accepted, registration fee will be refunded

If you choose credit card payment, the payment will be deducted from your card in Sterling. The Australasian Priory is currently using the United Kingdom’s credit card facility until such time as a credit card facility will be established in Australia. For this reason you need to mail your credit card authorization to the CR+C U.K. address. See the authorization form below.

Method of Payment:

(   ) Check  or  (   ) Money Order
Make remittances payable to Confraternity of the Rose Cross in the currency as indicated above.

Credit Card payment for USA, Canada and South America
(   ) Visa     (   )  Master Card    (   ) AMEX    (   )  Discover
Note: Credit Card statements will reflect a debit to "NAP-OMCE"  

Card #:

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Exp. Date: .... / ....
Name on the card:  
Billing Address: (if different than on the application form)__________________________

Cardholder's Signature: _____________________________

Credit Card payment for United Kingdom, Australia, Singapore, Philippines/Australasian region, India. This credit card payment authorization should be mailed to the U.K. address.

(   ) Visa     (   )  Master Card     (   )  Switch   (   )  JCB
Card #:

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

Start Date:  
Exp. Date: .... / ....
Name on the card:  
Address: (if different than on the application form)__________________________
Issue #: (Switch only)

Cardholder's Signature: _____________________________

Please Return Application to:

(If your country is not listed below, please contact us about the address you should mail your application to)

 

(for USA, Canada and South America)
Confraternity of the Rose Cross
PO Box 304
Tillson,  NY  12486-0304
USA



(for United Kingdom)
Confraternity of the Rose Cross
PO Box 490
Preston
PR2 6XF
United Kingdom

(for Australia, Singapore,
Philippines/Australasian region, India)
CR+C
PO Box 1746
Coffs Harbour
NSW 2450
Australia

* CR+C is the Rosicrucian Confraternity of the O.M.C.E.