Petition for Affiliation

Being persuaded that the Magical Golden Dawn can help me attain my spiritual, mental, emotional and physical goals; and being further induced by your openness to accept people of all races, creeds, colors, religion or spiritual path, I hereby petition for membership in the Magical Golden Dawn and warrant as follows:

_______ I am 18 years of age or older

_______ I have attained the rank of _________ in the ___________________________

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and offer as proof of this status ____________________________________________

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_______ I declare myself ready to proceed with my magical studies.

(Please print very legibly or type this document.)

Name: ______________________________________________________________

Address: _____________________________________________________________

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Telephone and/or Cell Phone _____________________________________________

Email Address ________________________________________________________

(All information provided is for internal use only and held in strictest confidence.)

Payment:

_______ I enclose payment in the amount of US $35.00 per person. Please make your check or money order payable to Universal Gnostic Church - MOGD and mail it to the following address:

Universal Gnostic Church
MOGD
PO Box 163
Ridgecrest, NC 28770-0163

_______ I am paying US $35.00 using the Pay Pal link below.

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Signature