*** Membership Rates (in US dollars): These prices are guaranteed until 12/31/99.

Family memberships may have only one address and receive only one Tome and one subscription to Requiem.

**Overseas members can join as a full chapter! Contact the Director of International Relations at one of the addresses below for more information.

******************** Membership Application *********************

This membership application must be mailed via the post.
Internet applications are not accepted because payment
must be included with the application. Avoid transmitting
credit card numbers via the internet!

Renewal?(y/n)____ If yes: Membership number?_________________________

Name (Real name please):________________________________________

Address:______________________________________________

_____________________________________________________

Please don't forget City, State, Zip Code,Country!

Phone number (with area code): _____________________________

Date of Birth:__________________ (Must be 18 or over)

Internet address (if any):____________________________________

Clan or Tribe of interest:____________________________________

Chapter affiliation (if any):___________________________________

Applicant Signature:_____________________________

Date:_______________________

I attest that all information contained in this application to be true to the best of my knowledge. I understand that misrepresentation or omission of facts requested by this application may be cause for dismissal from the organization. I agree to be r esponsible for my own behavior and, furthermore, I agree not to sue the organization due to injuries that result during live-action role-playing or club events.

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