Center Registration Form Please note: You may only register your own center if you are unable to contact your Sponsor, or they are unable to submit the information for you.  Please attach a copy of your certificate  with this form. Sponsor Information (the person who issued the center certificate) Sponsor Name:________________________________________________________________ Sponsor Address:______________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ Sponsor FOI Center: ______________________________________________________________ Sponsor E-Mail:_________________________________________________________________ New Center Information Center Name:______________________________________________________________________ Date Center Was Founded:_____________________________________________________________ If you are registering a Lyceum, please also put the Iseum name and date it was founded here: __________________________________________________________________________________ Founder (legal) Name:____________________________________________________________________ Founder Address:________________________________________________________________________ ________________________________________________________________________________________ ______________________________________________________________________________________ Founder E-Mail:___________________________________________________________________________ Deity / ies to whom this Center is dedicated:_________________________________________________________ Please include any further comments or instructions on the back of this form. Send this form to: Rev. Demetria Nanos Lyceum of Eleusis & Alexandria 6122 S. Kenwood Ave. Chicago, Illinois  60637 USA