In applying for membership, I confirm my belief in the Religion of Modern Spiritualism and the acceptance of its Principles. I further confirm that I am
familiar with the Religion, Philosophy and Science of Spiritualism and that I
have received satisfactory evidence of the continuity of life through
the demonstration of mediumship.
_______________________________________________________________________________________________

Name: _________________________________________________________________________

Address: _______________________________________________________________________

City: __________________State: ________ Zip:________Phone: _________________________

Email Address: __________________________________________________________________

Birth Day: ________________________Place of Birth: _________________________________

Name of Spouse (if married) _______________________________________________________

Business, Profession or Trade: _____________________________________________________

Business Address: __________________________________ Phone: ______________________

Are you a member of another denominational church or organization? Yes / No

Signature of Applicant: _________________________________________

TO BE COMPLETED BY THE PRESIDENT AND CHURCH SECRETARY

Affirmation of Faith _____________________________________________________________

Recommended by _______________________________________________________________

Date when approved by Church Board ______________________________________________

Date of Reception (Hand of Fellowship) _____________________________________________

President ____________________________ Secretary _________________________________