Application for Supporting Membership, Companions of the Glyph.

Date___________

NAME:___________________________________________________________DATE OF BIRTH_____________

PLACE AND TIME OF BIRTH (OPTIONAL)_______________________________________________________

CURRENT CONTACT ADDRESS:________________________________________________________________

____________________________________________________________PHONE____________________________

EMAIL___________________________________WEBSITE ADDRESS(ES)______________________________

BELOW AND ON THE REVERSE OF THIS PAGE, PLEASE GIVE AN IN-DEPTH BIOGRAPHY. INCLUDE HISTORY OF RELIGIOUS BELIEFS AND PRACTICES, SCHOOLING, NAMES AND RANKS OF ORGANIZATION TO WHICH YOU HAVE BELONGED. AFTER THAT, WRITE A PARAGRAPH EXPLAINING WHY YOU WISH TO ASSOCIATE WITH THIS PROJECT. NEXT, DISCUSS OUR INTENTIONS IN YOUR OWN AREA FOR INITIATING SUCH A PROJECT, IF ANY. FINALLY, READ AND SIGN THE STATEMENT OF COMMITMENT, STAPLE IT TO THIS APPLICATION AND MAIL THIS SHEAF ALONG WITH THE APPLICATION FEE OF $10. THE ADDRESS IS POB 40972, EUGENE, OR 97404. CASH CHECK AND MONEY ORDERS ARE AT THIS TIME ACCEPTED, IF MADE OUT TO COMPANIONS OF THE GLYPH.

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[to the Statement of Commitment]

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