Certificate Application Form

To Print: On PC Keyboard, Hold Control Button & Press P, as in Print / On Mac, It's Command P
REQUIRED: Please print legibly and remember to sign the document
Indicate your choice with a check mark for the kind of certificate you want: (you may choose both)

(   ) Religious Ceremonial Certificate for weddings & more... $15 minumum donation

(   ) Religious Cannabis Certificate for rites and prayers... $25 minumum donation

(   ) Gay Union Certificate... $25 minumum donation

Name: _______________________________________________________________________________________
          (as it will appear on the certificate)

Name: _______________________________________________________________________________________
          (full legal name)

Title: ________________________________________________________________________________________


Date: ________________________________________________________________________________________
          (that will appear on the certificate)


I, (Name) _____________________________________________________________________________________
have the sincerely held religious belief that I am...

a (Title) ______________________________________________________________________________________.
I agree to Ma’at (Truth and Justice) and will refrain from doing any harm.


______________________________________________________________________________________________
Signature:

______________________________________________________________________________________________
Mailing Address:

______________________________________________________________________________________________
Phone Number

______________________________________________________________________________________________
E-mail Address:

Make an online donation or place a check, money order or cash and this document in a stamped envelope addressed to:
Pr Ntr Kmt, c/o michaelm, 3345 Newport Bl, #204, Newport Beach, CA 92663, U.S.A..

and Now Donate