Bahá'í Declaration Form : (Please print)
_________________________________________________________________
Title (Mr., Mrs., etc)
Full
legal name-please do not use nicknames
Residence Address
________________________________________________
House or Space Number, Street or Description
_________________________________________________________________
City
State
Zip Code
Mailing Address___________________________________________________
_________________________________________________________________
City
State
Zip Code
[ ] Adult
[ ] Youth
Birth Date:____/__ _/____
MM / DD / Y Y
Telephone Numbers : Home (
) -
Work (
) -
E-mail Address:
By signing below, I declare my belief in Bahá'u'lláh,
the Promised One of God. I also
recognize the Báb, His Forerunner, and `Abdu'l-Bahá, the Center of His Covenant. I
request enrollment in the Bahá'í Community with the understanding that Bahá'u'lláh has
established sacred principles, laws, and institutions which I must obey.
Signature________________________________________ Date______________
Confirmation of Enrollment
To be completed by Local Spiritual Assembly or other
Bahá'í Agency.
Locality where individual lives:______________________________________
and its Bahá'í Locality Code (if known):_______________________________
Enrolling Agency _________________________________________________
Authorized Signature ______________________________ Date___________
Comments:______________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Please fill out the declaration form and mail it or fax it to :
Los Angeles Bahá'í Center
5755 Rodeo Road
Los Angeles, CA 90016-5013 FAX: 323-933-1820