Society of Mary On-line Life Membership Application Form

I, * * (Title: Rev'd/Mr/Mrs/Miss, etc.) * Declare that I am a member of the Holy Catholic Church and that I conform to her Discipline and Precepts, and desire to be admitted a MEMBER of the Society of Mary and hereby PROMISE to fulfill the Conditions and Undertake to Promote the Objects and keep the Rules of the Society. I enclose my Life membership herewith, $250.00.

1. *Signed:
2. *Date:
3. *Mailing Address:
4. Mailing Address 2:
5. *City:
6. *State:
7. *ZIP Code:
8. *E-mail Address:
9. *Phone:

Name of Cell or Ward with which I will be associated, if known: . For a list of active Cells and Wards, click here.

RECOMMENDATION: Name and contact information of a recommending Priest or Bishop (who need not be a member):

1. *First Name:
2. *Last Name:
3. *Mailing Address:
4. Mailing Address 2:
5. *City:
6. *State:
7. *ZIP Code:
8. *E-mail Address:
9. *Phone:

Verification

* I verify completing and submitting this form for myself alone, not on behalf of anyone else.