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:

_____________________________________________________________________________

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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