World Government of World Citizens

AFFIRMATION

I, the undersigned, do hereby, willingly and consciously, declare myself to be a Citizen of the World. As a World Citizen, I affirm my planetary civic commitment to WORLD GOVERNMENT, founded on three universal principles of One Absolute Value, One World, and One Humanity which constitute the basis of World Law. As a World Citizen I acknowledge the WORLD GOVERNMENT as having the right and duty to represent me in all that concerns the General Good of humankind and the Good of All. As a Citizen of World Government, I affirm my awareness of my inherent responsibilities and rights as a legitimate member of the total world community of all men, women, and children, and will endeavor to fulfill and practice these whenever and wherever the opportunity presents itself. As a Citizen of World Government, I recognize and reaffirm citizenship loyalties and responsibilities within the communal state, and/or national groupings consistent with the principles of unity above which constitute now my planetary civic commitment.

DATA CONSENT: By signing below, the applicant gives explicit consent (opts in) to provide and share their personal information and data.

X________________________________________________________
Signature of World Citizen and Date

Fill out below and sign Affirmation and Consent above and return with fee to: World Service Authority * 5 Thomas Circle, NW * Washington, D.C. 20005 * Tel: (202) 638-2662 * Fax: (202) 638-0638

APPLICATION FOR WORLD CITIZEN REGISTRATION

Please type or print all information

Please include your US$30 world citizenship registration fee and choose the left or right column below according to your preference of making an annual financial commitment:
FIRST NAME(S):______________________________________
FAMILY NAME:________________________________________
GENDER: M F
BIRTHDATE: DAY_____ MONTH_____ YEAR___
BIRTHPLACE:_________________________________________
TELEPHONE:__________________________________________
FAX:________________________________________________
EMAIL:______________________________________________
OCCUPATION:_________________________________________
CURRENT MAILING ADDRESS:
_________________________________________
_________________________________________
_________________________________________

Registration fee: US$30
Annual minimum contribution to
World Government (Optional): US$30
Required Postage: US$5
TOTAL: US$65


Registration fee: US$30
Annual minimum contribution to
World Government (Optional):
US$30 -or- US$___
Required Postage: US$5
TOTAL: US$___

Please check "Yes" below if interested:

_______ Yes, I would like to be contacted by other world citizens
in my region of the world.