Membership Application

Please complete all fields, check for accuracy and click the Submit button. You may also print out this form, complete and return it via the mail.

Full name (first, middle, last)

Mailing address (street or box)

City

State

Zip or postal code (if applicable)

Country

Telephone number (area code and number)

Email

How do you prefer to be contacted? (Check all boxes that apply)

Mail
Telephone
Email

Occupation

Date of Birth (month, day, year - time if known)

Sex

Male
Female

How did you hear about us?

Why do you want to become a Member of The Brotherhood of the Rosy Cross?

What do you expect to accomplish as a Member?

What are your interests in joining? (Check all that apply)

To progress spiritually
To heal the sick
To change the world for the better
To know God
To be part of a spiritual Brotherhood
Esoteric studies
Eternal youth, better health, physical longevity and spiritual immortality
To gain spiritual power to help others
Other

If Other, please explain.

What do you believe you can contribute as a Member?

If accepted as a Member, I agree to abide by the Rule of The Brotherhood of the Rosy Cross and agree to keep confidential and secret all information pertaining to The Brotherhood of the Rosy Cross and my membership in it, unless given permission in writing from the Brotherhood to do otherwise. I understand that all instructional material I am sent is on loan and remains the property of the Brotherhood. I swear by Almighty God and my word to use all knowledge and powers I gain by my membership only for purposes of good. I further affirm that all information submitted on this application is true and correct to the best of my knowledge. So help me God.

I agree
I do not agree (clicking here will result in automatic disqualification)

I am sending my donation ($75 minimum) by:

PayPal - check or credit card
Postal mail - check, cash or money order