Application for Membership

1
Surname* This field is required.
2
Given Name(s)* This field is required.Include title
3
Other/Former Name(s)
4
Residential Address* This field is required.Type your address below, or if you are home, use the location button.
Street Address
Street Address Line 2
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Country
5
Parish* This field is required.
N- Bankstown (St. Nicholas)
N- Croydon Park (St. John the Baptist)
N- Doonside (Sts. Peter & Paul)
N- Goulburn (St. Anna)
N- Kirrawee (St. Michael)
N- Mays Hill (St. Mary's Nativity)
N- Mt. Pritchard (St. Mary's Dormition)
N- Punchbowl (St. Nicholas)
N- Redfern (St. George)
N- Ryde (Sts. Michael & Gabriel)
N- Wollongong (St. Elias)
Q- Sunshine Coast (St. Mary Magdalene)
Q- Woolloongabba (St. Paul)
S- West Croydon (St. Elias)
V- Clayton (The Good Shepherd)
V- Dandenong (St. Paul)
V- Darraweit Guim (St. Ignatios)
V- East Melbourne (St. Nicholas)
V- Kingsville (St. Mary's Annunciation)
V- Thornbury (St. George)
Philippines
New Zealand
Other
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6
Current Position Held* This field is required.
7
Date of Birth* This field is required.
Date
Day
Month
Year
8
Usual Occupation* This field is required.
9
Email* This field is required.
example@example.com
10
Mobile* This field is required.
11
Landline
Please enter a valid phone number.
12
Applicant Declaration

By signing this document, I apply for membership of the Antiochian Orthodox Archdiocese and agree.

a) to the terms of the constitution of the Antiochian Orthodox Archdiocese, including the guarantee amount of

b) to pay the membership fee (if any) payable by Members.
13
Signature* This field is required.
Clear
14
Membership FeeAnnual Membership Subscription
prevnext( X )
Archdiocese Annual Membership
The minimum is $1, or membership will not be valid or choose a custom amount. Automatically renewed each year.
AUD for each year
SUBSCRIBE
First Name
Last Name
15
Dated* This field is required.
Date
Day
Month
Year
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