THE ORDER of ST. GEORGE Grand Patron: H.E. Col Dame Iris Karászy-Kulin MKN GCStG DCLJ CMLJ Spiritual Protector: H.E. The Reverend Canon The Chevalier Andrew White GCStG Grand Prior: H.E. The Chevalier Simon McIlwaine MKN GCStG KL CLJ MMLJ MA FRSA FRSM ACIArb Patrons: His Grace Bishop Angaelos GCStG and The Baroness Cox GCStG Petition I hereby petition the Grand Prior for admission to the International Knightly Order Valiant of St George and confirm that I will, if appointed a member of the Order, agree to be bound by its Statutes as amended from time to time. To assist with consideration of my application I have set out below the requested data and agree to this information being stored in the computer database of the Order and used by it for internal administrative purposes. I confirm that I have no unspent criminal convictions that resulted in a prison or suspended sentence. Title ______________________________________ Family Name ___________________________________ Forenames ________________________________________________________________________________ Address___________________________________________________________________________________ Telephone Home ____________________________ Telephone Mobile ______________________________ E-Mail _____________________________________ Facebook or LinkedIn ID ________________________ Date of Birth ________________________________ Nationality ____________________________________ Religious denomination _______________________ Occupation ____________________________________ Membership of other Orders (state ranks) _______________________________________________________ _________________________________________________________________________________________ Measurements for cape of the Order. Height (ft/ins) ________________ Signed ____________________________________ Dated ________________________________________ Sponsor* (signature) ___________________________ Name of Sponsor* _______________________________ * Optional Please return completed form together with a copy of your CV or resume to: H.E. The Chevalier Frank Moxon GCStG, Grand Secretary, Ancient Meadow House, Millway Lane, Palgrave, Suffolk IP22 1AD Tel: 01379 640 800 E-mail: [email protected] Website: www.george.st The International Knightly Order Valiant of St. George is registered as a charity in England. Charity number 1137397