APPLICATION FORM

SURNAME...........................................................
CHRISTIAN NAME(S) ...........................................
ADDRESS ..........................................................
...........................................................................
TEL. ................ FAX ......................................
E-MAIL ........................
DATE OF BIRTH ...../...../...... CITIZENSHIP ....................
RELIGIOUS DENOMINATION ...........................................
QUALIFICATIONS ..........................................
PROFESSION .......................................................

Place a tick beside your choices:
.... I wish to register for the entire programme of the Academy
.... I wish to participate for three weeks only (please indicate the starting and ending dates).
.... I wish to participate for two weeks only (please indicate the starting and ending dates).
.... I wish to participate for one week only (please indicate the starting and ending dates).
.... I wish to join the final excursion (1-2 September 2001).

I wish to participate in the Academy of Orthodox Christian Studies and enclose my deposit for $US ........... (Cheques payable to the Holy Metropolis of Dimitrias.)