Member Application Form
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First name *
Middle name *
Last name *
Address (Number and Street and Apt #) *
Northern Mariana Islands
Federated States of Micronesia
District of Columbia
Armed Forces Pacific
Armed Forces Europe, Middle East, & Canada
Armed Forces Americas
Home Telephone # *
Cell phone # *
Previous Parish (India/USA) *
Home Parish in India and Diocese *
Spouse's Previous Parish (India/USA) *
Spouse's Home Parish in India and Diocese *
Clearance Certificate from the previous Parish received? *
Copy of Baptism / Marriage Certificate
Membership Details(Please list all the family members including you):
Name of the Member *
Relationship to the primary member *
Date of Birth *
Date of Marriage *
Initial Payment (2 x Monthly Subscription)
Donation to building Fund- Minimum $1000.00 of $5000.00. Remaining balance of Building fund must be paid completely within 5 years. $
Total Initial Payment
I/We hereby apply to be received as member(s) of the parish. The information given above is true to the best of my knowledge. I will abide by the canons and the Constitution of the Malankara Orthodox Syrian Church, the By-laws of the parish, and be obedient to the Holy Episcopal Synod, the Catholicate of the East and the Northeast American Diocesan Metropolitan. I understand that my membership status will be active only if I pay the basic membership and other dues to the parish each year.
Application is subject to the approval of the Vicar.
The filing of an Application does not mean that the applicant is entitled to member privileges of this Parish.