Membership Application

First Name (required)

Last Name (required)

Your Email (required)

If we do not have your current email we cannot confirm your membership or add you to our mailing list for notices and renewal reminders. Please remember to update us if you change your email address.

Address (required)

City (required)

State or Province (required)

Country (required)

Zip or postal code (required)

Home Parish (required)

Diocese (required)

Age (required)

Sex (required)

Occupation (required)

Telephone

Area of Historical Weapons Interest?

Prior Martial Arts Training

Past historical combat / martial arts organization affiliation or membership

Present historical combat / martial arts organization affiliation or membership

Have you read through, understand and agree to the Order of Lepanto Code of Chivarly and Conduct?

Are you applying individually or as part of a group?

If group membership - which group?

How did you learn about us?