(Last) (first) (middle)
Date of Birth: (must be 18+years of age):______________________Gender:___________
Phone Number:_____________________________ E-mail: _________________________

Educational Level reached in school:___________________________________________
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.

Schedule of fees:
Registration $25.00  
Quarterly dues $30.00  
Annual Dues $110.00  

Amount remitted with this application:

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