The Rosicrucian Order

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Application for Membership (Applicant must be over 18 years old)

Surname		Title (Mr, Mrs etc)
First Name		Initials
Address		GSM Phone No.
E-mail		Postal Address
Birth Date	Day Month Year

Current Educational Qualifications

Please state your reasons for wanting to affiliate with The Rosicrucian Order AMORC

Are you a member of any esoteric organization? if YES please give details YES NO

Membership Dues
Please note the following:
1.Your membership dues can be paid quarterly, semi-annually or annually. It is in your interest to pay annually to avoid inactive status.
2. The current dues rate structure is as follows:

	SINGLE MEMBER	COMPANION MEMBERS
Registration	N 3,000	N 4,000
Quarterly Dues	N 4,500	N 5,000
Semi-Annual Dues	N 9,000	N 10,000
Annual Dues	N 15,000 (If paid once)	N 18,000 (If paid once)

3. Payment is registration plus one quarter’s or annual dues.
4. Dues Payment should be made to any of the following banks:

FIRST BANK-
ACCOUNT NAME: AMORC FUNDS
ACCOUNT NUMBER: 2008090498.

ZENITH BANK-
ACCOUNT NAME: AMORC FUNDS
ACCOUNT NUMBER: 1010926207
5. Alternatively, payment may be made by means of a Bank Draft or Cashier’s Cheque made payable to AMORC FUNDS and sent by registered mail.
6. Companion membership is open to husband and wife only.

ENTER PAYMENT DETAILS (AS IT APPEARS ON YOUR TELLER)

Bank of Payment		Branch/Location
Account Number		Date of payment
Amount Paid (N)		Teller Number
Depositor's Name		Comments

Optional Information

How did you hear about the Rosicrucian Order?
Friend Family Member Newspaper or Magazine Advert
Member of AMORC (Please provide Key Number)
AMORC Literature Radio Jingle Search Engine Our Website
Other (Please specify)

Terms & Conditions (Click on the box below to accept)
I hereby request to unite with the Rosicrucian Order, AMORC in their studies. If I am accepted, I will abide by the governing documents of the Order and by the traditional pledge made by all members, to keep confidential all monographs and study materials which I understand always remain the property of the Rosicrucian Order, AMORC.

I Accept