Moorish Science Temple

THE DIVINE AND NATIONAL MOVEMENT OF NORTH AMERICA, INC., #13

THE MOORISH AMERICAN NATIONAL REPUBLIC
P. O . Box 23408—Baltimore, Maryland 21203
_______________________________________________
DEPARTMENT OF EDUCATION
MOORISH SCHOOL OF LAW AND HISTORY
REGISTRATION FORM FOR CONTINUING EDUCATIONAL
TELE - CONFERENCE COURSES

Date of Class: Every Wednesday From 8PM-10PM Eastern Time

Title of Class: NATIONALITY AND IDENTIFICATION CARD COURSE
Conference Call Number/Access Code: Given On Orientation Day
Class Code: 42406; Duration of Class: 8-10 Weeks

Name: _____________________________________________________________________________
Address: ___________________________________________________________________________
City/State/Zip:_______________________________________________________________________
Telephone: ________________________; Cell: ___________________Fax: _____________________
Email: _____________________________________________________________________________
Dated of Naturalization: ______________; Place: __________________________________________
Date of Birth: ______________________; Place of Birth: ____________________________________
Female: ___________; Male: ___________; Age: ______ Adult: ________; Young Adult: _________;
SSN# ________________________; Certificate # _________________________
Place of Proclamation: ____________________________________________________________
__ I HAVE NOT BEEN NATURALIZED

Make up classes may be done via weekly taped recordings. Notify Sheikess Bellamy-Bey Registrar Secretary
via email if you cannot attend a class once you have registered. Attendance will be taken each week. Periodic
assignments and projects will be assigned to the class. Assignment completion is required in order to receive
your Certificate of Completion for the course. *Restrictions apply to number of make up classes—
absenteeism is two days out of 8 weeks.*
MANR CITIZEN RESPONSIBILITIY: COURSE FEE: $70.00
Are your dues current? Yes__; No __; If not, when will they be current?: Month: ___; Day: ____; Year:
____ NOTE: Members: $20 per month; Officers: $35 per month

NON MANR CITIZEN RESPONSIBILITY: COURSE FEE: $125.00

Facilitators:Members of MSLH's Board of Education

National Grand Sheik Bratton-Bey, Deen of MSLH
Sheikess Bellamy-Bey, National Registrar
Sheik Lee-Bey, Director of Education
FAX REGISTRATION OR MAIL TO: Office of National Registrar, Moorish American
National Republic, Sheikess Bellamy-Bey, P.O.Box 23408, Baltimore, Maryland 21203
CALL: Office of National Registrar Secretary in Maryland 410-488-6858
EMAIL: mnrofficeofregistrarsecretary@gmail.com
**Course Voucher: Course Fees are valid for one year towards naturalization process for those that are not yet naturalized.
Course Voucher expires after one year. Mandatory Requirement For Everyone To Take All Three MSLH Courses.**

Form 1099-R-46