Membership Application Form Person Completing Information: City State ALABAMA ALASKA AMERICA SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLOMBIA FED ST OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTH MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Country Peace Club of Choice: CITY CHAPTER PEACE CLUB INSTITUTIONAL AFFILIATE AFRICAN CHILDREN OF PEACE CLUB KAYERO PEACE CLUB KAIROS PEACE CLUB SILVER PEACE ALLIANCE CLUB NEW WORLD PEACE LEGACY CLUB INTERCESSORS FOR PEACE CLUB YOUTH ECONOMIC EMPOWERMENT PEACE EDUCATION CENTERS If you are a new applicant, please check here If you are returning member, please check here Is there any Peace Club in your city or locality? If yes, please indicate name, if known Peace Club Name: Coordinator/Chairperson/Officer List of Your Spiritual Leaders Date Launched, if known Membership Strength, if known
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