The Federation of Circles and Solitaries

              P.O. Box 22  ~ Wyandotte, Michigan   48192       http://www.focasmi.org

                              Membership Application

            Contact Information

                Name _________________________________________________________ Age ________________________

                Public Magickal Name _______________________________ D.O.B. ______/______/_______________________

                Address___________________________________________ City _____________________________________

                State _____________ Zip ______________ Primary Phone # __________________________________________

                Email Address _______________________________________________________________________________

            A Little About You

                Do you follow a Pagan Spiritual Path? ________ Which one? ___________________________________________

                How long have you been practicing? ______________________________________________________________

                Do you belong to a Coven, Grove, Learning Circle, etc? ________________________________________________

                If not, would you like information about them? _______________________________________________________

                What special mundane or magickal talents do you have? _______________________________________________

                Would you be interested in working on one of our FOCAS Committees?  

                            Charities  ______                 Clergy ______               Membership  ______               

                            Outreach  ______                Media  ______                         Events  ______               

            Below is our Fourfold Mission Statement (More info can be found at www.focasmi.org)

·       Healing the Earth through preservation of wildlife and habitat;

·       Fostering unity within the Earth-Based Spiritual Community through Open Communications, Networking and

        Cooperative efforts;

·       Educating the community at large in the tenets of Earth Based Spiritualities in order to increase tolerance and

        acceptance of Earth Based Spiritualities;

·       Acquiring land for the express purpose of exercising our constitutional Right to Freedom of Religion without

        fear of molestation, harassment or interference.

            I agree with the Federation of Circles and Solitaries mission, and want to become a member.

                I request my Membership remain confidential; no mail or phone calls. (Please check) __________

                Signature ________________________________________________ Date _________/_________/_________

                Office Use:

                Shirt Size ___________________________________        Membership Number ______________________________________

                Shirt Received _______________________________        Membership Card Received _________________________________