Church of the Gnosis Kardias, Evansville, Indiana

Petition for Membership

All information provided in your petition is kept confidential.

PETITIONER INFORMATION

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Nation of Citizenship *

Phone Number *

Email *

Date of Birth *

Sex *

Male Female

Marital status *

Single Married

Occupation *

Previous occupation *

Have you ever been charged, arrested, or convicted of any offense or crime (other than minor traffic violations)? *

Yes No

If yes, please explain nature of offense(s), dates of offense(s), and judgment(s) rendered. *

ACADEMIC INFORMATION

Most recent school attended: *

Dates attended: *

Last degree earned and graduation date *

Please list the same for any other colleges or universities attended, beginning with the most recent. *

RELIGIOUS AFFILIATION

Do you affirm a belief in a Supreme Being? *

Are you baptized? *

Yes No

If yes, in what tradition? *

If you identify with a primary faith tradition, what is it? *

FRATERNAL AND ESOTERIC AFFILIATIONS AND STUDIES

List any fraternal, initiatic, and religious organizations and Orders with which you have been affiliated, both past and present, including degrees received and dates received. *

Have you ever been denied membership in or been suspended or expelled from any organization? *

Yes No

If yes, please explain. *

Which Order are you petitioning (choose only one)? *

Athenea Theologica (Gnostic Church) Ordre Martiniste of North America Aesthetic Rose+Croix Order of the Temple and the Grail

Please elaborate on how you developed an interest and why you wish to join this particular group. *

By checking this box, I affirm the truth of these statements.

I affirm that I believe in God, a Divine Intelligence, or a Supreme Power. I further promise that I will exercise patience, respect, benevolence, understanding, and love towards my brothers and sisters. I further promise to guard and keep private and confidential all materials entrusted to me and labeled as such.