CTE Membership Application Form

Membership Application Form

Apply to join the Centacle Theokratia Ekklesia.
Full Legal Name (as appears on government-issued ID)

First NameLast Name
Date of Birth (mundane)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Place of Birth
Current Primary Residence Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Previous Residences (last 5 years – list each address with approximate dates)
Current Occupation / Profession
Employer (if applicable)
Affiliation with other orders, organizations, lodges, religious groups, or sovereignty movements (past or present) (Include names, dates, and nature of involvement. Full disclosure is required for screening.)
Email Address
example@example.com
Phone Number (optional)
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about the Ekklesia?
Select your Membership Tier
Hardship Explanation (required if applying for Mercy Tier)
AFFIRMATIONS Please initial each statement to confirm your understanding and agreement.
I affirm that I am entering this application and covenant voluntarily, freely, and without any coercion, duress, undue influence, fraud, or deception of any kind.
I acknowledge that I have had the opportunity to ask questions and seek clarification regarding all terms, and I fully understand the spiritual, legal, and eternal implications of membership.
I expressly consent to initial and ongoing background screening by the International Celestial Interpol Unit (ICU) Military-Police Command, based on information provided in this application and any future interactions with the Centacle Theokratia Ekklesia, its membership and subordinate orders and Kalumite citizens
I acknowledge that submission of this application immediately binds me to the exclusive jurisdiction of the Holy Royal Imperial Sangreal Sovereignty of the Theocratic Dominion of Kalum Parish, Eheieh, under Kalumite Theocratic Law.
Signature
Printed Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: