1. Full Name (as you wish it to appear on your certificate):

_____________________________________________________________________

2.Your Mail Address: ___________________________________________________

___________________________________________________

3. Date awarded Knight Of the Order, Second Class (Officer) ____/____/____ (month/day/year)

4. Check One: ______Male _____ Female

5. You must agree to the following to be advanced by our order and receive the rank of Knight Of The Order, First Class (Commander): "I state that I seek to advance in The International Order of the Knights of Saint Luke for honorable purposes and with a sincere heart. I agree to endeavor to follow the discipline of this rank, to engage in regularly scheduled prayer, practice compassion in my daily life even beyond what might ordinarily be expected, and to be an enthusiastic evangelist of our Lord and Savior Jesus Christ, that I will always seek to do my best for the order, that I will endeavor to act to always reflect well on the order, and that I will respect and show true Christian love and compassion toward all peoples, and especially my fellow members of this order. I further state that I will also seek to always reflect positively on Saint Luke Evangelical Christian Ministries, the sponsoring ministry of this order."

________ I agree to the above. (order cannot be processed unless checked)

Copy and paste this form into the body of an e-mail, fill it out appropriately, and e-mail it to Brother Dave. Use PayPal to send in your contribution of $50.00.