.S.D. ...............

Countersigned by ..........................................

DO NOT DETACH.

To the applicant: Name ...... Mrs. Jennie W. Field, C.S. ......
Please fill out the Street and Number ... 18 Forest St., ........
following for the use Town or City ............ Chicago, ..........
of the Treasurer of State ............................ Ill ......
the Church:

Application I

PROPERLY SIGNED AND ENDORSED,

ACCORDING TO ARTICLE V, SECT. 2

If you have been taught by a loyal student who has taken a degree at
the Massachusetts Metaphysical College, or by one who has passed an
examination by the Board of Education, fill this blank.

FORM 1

The First Church of Christ, Scientist, in Boston, Mass., is
designed to be built on the rock of Christ--Truth and Life--and to
reflect the Church Triumphant.

One who is not a member of any church, excepting a branch church
of Christ, Scientist, who loves Christian Science, and reads
understandingly the Bible, and SCIENCE AND HEALTH WITH KEY TO THE
SCRIPTURES, by Reverend Mary Baker Eddy, and other works by this
author, and who is Christianly qualified and can enter into full
fellowship with the Tenets and Rules of The First Church of Christ,
Scientist, in Boston, Mass., is eligible to membership.

_To The First Church of Christ, Scientist, in Boston, Mass._

Gordon V. Comer Clerk.

I hereby make application for membership, and subscribe to the
Tenets and the By-Laws of the Church.

My teacher in Christian Science is
...............James B. Brown, C.S.D. ..................

I am not a member of any church, excepting Church of Christ,
Scientist, at ........................

FORM 1--(Continued)

I was formerly a member of the .............................
............ denomination, but have definitely severed my
connection therewith.

Name .............. Mrs. Jennie W. Field, C.S. ..........
Street and Number ....... 18 Forest St., ................
Town or City ................ Chicago, ..................
State ............................ Ill ..................
Date ................. Jan. 2nd, 1901 ...................

I cordially approve the applicant.

(a) ............... James B. Brown, C.S.D. ...............

Countersigned by ..........................................

DO NOT DETACH.

To the applicant: