Application for Active Membership
in the Church of Satan
The following may be printed out and, upon completion, mailed to:
Church of Satan, P. O. Box 210666, San Francisco, CA 94121 USA
You must already be a Registered Member before submitting this, or you may submit this application
along with your Registration Statement and the $100 Registered Membership fee (see the
Affiliation Page for more details). This application may only be submitted in hard copy via the mails.
Note: The $100 fee is for Registered Membership only - it is a one-time fee for
lifetime Registered Membership. Active Membership may be applied for, with no additional
fee, by Registered Members. Be aware that if you resign your membership in the Church
of Satan, you will be treated as if you never were a member, so will have to
re-register and pay the fee again.
Provide answers to all questions to the best of your ability. All data is held in strict confidence.
PART I
Complete Name: _________________________________
Mailing Address: _________________________________
Telephone: _____________________________________
Sex: ____________
Marital Status: _____________________
Date of Birth: ______________________
Place of Birth: ____________________________________
Height: __________________
Weight: __________________
Color of Eyes: ______________
Color of Hair: _______________
Name, Birthdate and Birthplace of Spouse: __________________________________________
Number of Children/Ages: ______________________________________________________
Previous Religious Affiliations and Offices: ___________________________________________
Nationality: ______________________________________
Ethnic Background: _________________________________
Citizenship: _______________________________________
Educational Background and Degrees: _______________________________________________
Present Occupation: ____________________________________________________________
Special Interests, Talents, Abilities Hobbies or Collections: _________________________________
I am interested in participating in local Grotto activities: ___Yes ___No
I am interested in being considered as a candidate for Grotto Master status___Yes ___No
I am interested in serving as a contact point or media representative in my area ___Yes ___No
PLEASE ENCLOSE A RECENT PHOTOGRAPH WITH THIS MEMBERSHIP APPLICATION
--------------------------------------------------------------------------------
PART II
Provide answers to the following questions on additional sheets of paper.
1.) What are your impressions of The Satanic Bible?
2.) What do you expect to accomplish through membership in the Church of Satan?
3.) If you were granted three wishes, what would they be?
4.) What is your attitude toward animals? If you have any pets describe them. What is your ideal?
5.) Are you satisfied with your sex life? Describe your ideal of a physically attractive sex partner.
6.) What is your life's goal, and what steps have you taken to attain it?
7.) Do you find any of our tenets objectionable? If so, which and why?
8.) How many years would you like to live?
9.) What are your musical tastes? Provide examples.
10.) Cite four motion pictures you consider your favorites, and why.
11.) What are your food preferences?
12.) Cite four books you consider favorites, and why.
13.) If you own an automobile, describe it. What is your ideal automobile?
14.) As a child, what were your favorite pastimes? What was your disposition?
15.) Of which country other than the one in which you now reside would you prefer being a resident?
16.) In what type of dwelling do you live? Describe your ideal home.
17.) Describe your political philosophy.
18.) What is your personal definition of magic?
19.) Do you feel oppressed or persecuted in any way? If so, explain.
20.) Are you self-sufficient or are you most productive in a group?
21.) Do you make friends easily if you so choose?
22.) What is more important to you, self-satisfaction or approval from others?
23.) Would you rather influence or be influenced?
24.) Do you feel you have leadership abilities?
25.) Do you consider yourself a good judge of character?
26.) In what organizations do you hold membership?
27.) Have you possessed or used illegal drugs? If so, explain in full.
28.) Describe a significant experience in your life bordering on what you would consider the paranormal or demonic, if any.
29.) What forms of entertainment do you prefer?
30.) Tell one of your favorite jokes.
31.) Have you served in the armed forces? If so, provide pertinent data.
32.) How long did it take you to join the Church of Satan?
33.) Are you a smoker? If so, to what extent.
34.) Have you accomplished anything important or significant? If so, what?
35.) Which parent do you admire most and why?
36.) Do you drink alcoholic beverages? If so, to what extent? State preferences.
37.) Do you have any tangible services or resources which you would care to contribute?
38.) Are you free to travel? To what extent?
39.) Define Satan.
40.) Provide your signature attesting to the above, and enclose photograph.
--------------------------------------------------------------------------------
FOR OFFICE USE ONLY:
Initial Application Processing Date _____ Photograph Enclosed _____