TO THE BOARD OF DIRECTORS OF THE ST. VLADIMIR SOCIETY

Send to:
Board of Directors
P. O. Box 143
Jackson, NJ 08527

DECLARATION

From:

I ask to be accepted as an active member of the St. Vladimir Russian Orthodox Society of America, Inc.

I am a parishioner at:

I confess and partake of the Holy Communion at least once a year.

Two members of the Society recommend me:

1)

2)

* If you do not know two members, please talk to our priests. They are members and can recommend you to the Board.

I enclose member dues for one year in the amount of $60.00.

My mailing address is:

My e-mail is:

Signature: ______________________________________________________________