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APPLICATION TO JOIN THE ALBANY, NEW YORK CHAPTER

This is the membership application for the Albany, New York Chapter of Earthwise Gyre. To apply for membership at a different Chapter, please see the local Chapter Directory. Before completing this application, note that you must already be a member in good standing of this Chapter’s chosen Pagan charity: The Correllian Nativist Church International, Inc. If you are not yet a member of the Correllian Nativist Church, please visit the Correllian website and subscribe for membership there before applying to the Albany, New York Chapter of Earthwise Gyre.

By completing this form you confirm that you are only submitting your own information, that you are 18 years of age or older, and that you actively grant your consent for the Albany, New York Chapter of Earthwise Gyre to share this information with its chosen charity for the sole purpose or confirming your current and future membership status.

Your Full Legal Name:

Your Craft Name (If Any):

Your Email Address:

Your Street Address:

Your City & State:

Your Zip Code:

Your Phone Number:

Your Member Code (If Any):