I hereby apply for a Lifetime Membership in the International Association of Scientologists.
I understand that the purpose of the Association is to unite, advance, support and protect the Scientology religion and Scientologists in all parts of the world so as to achieve the Aims of Scientology as originated by L. Ron Hubbard.
I promise to abide by the rules, codes and policies of Scientology and I do not belong to or work for any hostile organization or group or any group that is dedicated to the harming of mankind.
I understand that the membership fees are stated as a minimum amount and that the Association accepts donations of any size. All donations will be used towards the protection of the Scientology religion and the fight for freedom for all mankind.
I also understand that membership fees, donations and contributions are not refundable.
I am applying for a Lifetime Membership in the International Association of Scientologists. Fees for a Lifetime Membership are U.S. $5,000.
I am making a partial payment toward my Lifetime Membership.
I wish to become a Monthly Supporter of the IAS.
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Amount (All amounts are in US dollars)
Please let us know what prompted you to apply for your IAS membership today:
An e-mail or letter I received
Ad in a Scientology magazine
Membership information I received from a staff member
Any comments you would like to make?
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Data protection/privacy: The data you provide on this form will be held in a secure database of IAS Administrations in Los Angeles. The data will be used for IAS membership administration purposes and to keep you informed of activities, offers and services of the Church of Scientology, and to send you membership-related mailings. By filling out and signing this form, you agree to the transfer of the data to IAS Administrations in the USA and to the passing of any of these data to those entities belonging to the Church of Scientology, who are commissioned to perform the request for information about Scientology on behalf of IASA, for the above purposes. IAS Administrations and those churches commissioned as above, fully respect your privacy. Your information is never disclosed to anyone outside IAS Administrations and the worldwide Church and its associated entities. You can verify your membership data held by IAS Administrations, or ask us to stop sending you mailings at any time simply by writing to us.