Pre-Membership Application

Every field must be filled out as accurately as possible. Any misinformation, blank fields, or failure
of identification will result, without notice, of termination of your application and your ability to
resubmit an application. Do your best to fit your answer in the space provided. You may either write
your answers by hand and scan the document, or fill in the blanks and send the document as an
attachment. Email application along with scanned proof of identification to
applications@joinilluminati.com for review. Upon acceptance, postage and address will be provided
for your membership verification application.
DO NOT include any personal information about yourself such as:
- Social Security Number
- Credit Card Number
- Bank Statements
- Birth Certificates
First Name:
Last Name:
Location of Residence (street address):
City of Residence:
State of Residence (if applicable):
Personal Email:
Personal Telephone*:
Date of Birth**:
Hospital of Birth***:
Short-term Goal (s):
Long-term Goal (s):
Desired Contribution (to society):

Prior Attempts To Join:

Explain What You'd Like To Accomplish as a Member:
Referrer (if applicable):
Comments:
Digital Signature****:
* Use your cellphone number. If you dont have a cellphone number, use a landline phone number
of either yourself, a relative whose billing records could be traced back to you.
** As listed on your birth certificate. Do not include a copy of your birth certificate.
*** Leave blank if unknown. If you were conceived in a residence, include the city and country
which you were born in and your birth certificate records would be located in.
**** Print your full legal name authorizing acceptance of the terms of conditions.