Membership Application

The Society of Saint John Chrysostom - Western Region Please print and mail to the address at the bottom of the form. Date: ___________________________________________________________________ Last Name: ______________________________________________________________ First Name: ______________________________________________________________ Sponsor (for Associate members) ___________________________________________ Type of membership: Full _____________ Associate (non-voting) ______________ Please note: Full Membership is only for members of Canonical Catholic or Orthodox jurisdictions. Dues (payable by June 30 each year and includes national SSJC membership): Full: $50.00/year; Associate: $40.00/year; Monastics/ Students: Please consult Treasurer. Mailing Address: (Light of the East, the SSJC-WR newsletter is mailed to paid members) Street: ____________________________________________________________________ City/ State/ ZIP_____________________________________________________________ Telephone (optional unless no e-mail address)_____________________________________ E-mail (SSJC-WR notifications and communications are preferentially sent by e-mail): ___________________________________________________________________________ Your Canonical tradition/jurisdiction: Roman Catholic ____ Eastern Catholic ____ Eastern Orthodox _____ Oriental Orthodox ___ Other ________________________________ (Associate membership only. Associate members must be sponsored by a full member.) Your Diocese/Eparchy and name of Bishop: _____________________________________________________________________________ Your Pastor and parish: _____________________________________________________________________________ Talents or interests you would like to share with the Society of St. John Chrysostom: ______________________________________________________________________________ Please make your check or money order payable to: “Society of St. John Chrysostom.” Mail to: Robert Greenwell, Treasurer, 2700 Katherine Street, El Cajon, CA 92020.

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