FORWARD IN FAITH INDIVIDUAL MEMBERSHIP FORM

Name______________________________Title______Order (lay, clergy,
etc.)_______

Address__________________________________City__________________________

State______________________Zip__________Country_________________________

Telephone: Home______________Business______________Cell__________________

Fax________________________E-mail______________________________________

If family membership, spouse's name________________________________________

Confirmed children at home________________________________________________

Parish________________________________Diocese___________________________

Jurisdiction_________________________________
(e.g. - MDAS, ACNA, DHC, Anglican Church of Canada, etc.)

MEMBERSHIP DUES LEVELS (select one; amounts are per year):
____$50 Individual supporter (minimum)
____$75 Family (minimum)
____$25 Students and those on fixed income (minimum)
____$100 Donor
____$500 Sustainer
____$1,000 Sponsor
____$5,000 Patron
____$10,000 Benefactor

____ CHECK # ____
____MC/VISA/DISCOVER#____________________Exp. Date________
DISCOVER cards also require 3 digit CID from signature area of
card______

Checks should be made payable to

Forward in Faith North America

P.O.Box 210248, Bedford, TX 76095-7248.

All gifts are tax deductible to the extent of the law.