Request an Application

Please complete the form below to request your personal Application for Nomination to The Academy of the Jamilian University of the Ordained. Your application will be sent to you in electronic format. If you prefer a hard copy version, you may request one be sent from the form below.

Please remember, when you order one or more books, your University Application Processing Fee of $50 will be waived for thirty days from the time of purchase. Order your books today.

1. First Name *
2. Middle Name
3. Last Name *
4. Title Mr. Mrs. Ms. Dr. Rev.
5. Mailing Address *
6. City *
7. State *
8. Province
9. Zip *
10. Country *
11. Home Phone
12. Office Phone
13. Mobile Phone
14. Office Fax
15. Email *
16. IM Screen Name AIM Google Talk Windows Live Messenger Skype Yahoo! Messenger GaduGadu ICQ QC Nate On Twitter Hyves Orkut Cyworld Mixi QIP
17. Screen Name
18. Personal Website
19. How did you hear about us? Magazine Ad Jamilian University Website Internet search Word of mouth Previous contact with Jamilian University Related Jamilian Univeristy site - Advocates for Religious Rights - Andean Explorers Foundation - Community of Christ - Cosolargy - Gene Savoy - Project X - Steamboat Hot Springs Other
20. Other (please specify)
21. Yes, please send me a printed copy of the Jamilian University Application by mail.
22. Comments/Questions