BROTHERHOOD OF THE WHITE TEMPLE, INC.

FELLOWSHIP OF THE AVATAR APPLICATION FORM

Print out the following APPLICATION for FELLOWSHIP OF THE AVATAR.

REQUEST FOR MEMBERSHIP

• I desire to become a disciple of the Avatar and will sincerely and earnestly strive to live in harmony with Divine Law so that I may, by example, draw those around me to the "Path". I will work with all my might to establish the Brotherhood of  Man and the Christ-Kingdom on earth.

• Minimum contribution of $3.00 per month is required. Enclosed: $__________

Method of Payment

United States:  Check, Money Order or Visa/MasterCard

All other countries:  International Postal Money Order drawn from a U.S. Bank

or

International checks drawn on a U.S. Bank

or, Visa/MasterCard drawn on a U.S. Bank

PLEASE PRINT

Name:

_________________________________________________

Street Address:

_________________________________________________

_________________________________________________

City:

_________________________________________________

State:

_________________________________________________

Zip Code:

_________

Country

_________________________________________________

Signature:

_________________________________________________

Mail Application to:

Brotherhood of the White Temple