Membership Application Form

Membership Type (choose one)



Rank/Participation (choose one)













First Name
Last Name
Address 1
Adress 2
City, State and Zip Code
Home Phone (no dashes or dividers)
Cell Phone (no dashes or dividers)
Email Address
Date of Birth *Must be over 18 to join
Emergency Contact- indicate relationship
Emergency Contact Number
*Roman Persona Name (see suggestions)
**Additional Family Members
Who recruited/invited you to join
Any Additional Materials to Loan







Related Reading Completed









Expectations
Skills
Experience
Any Special Needs/Challenges



Explanation
***Agreement to Rules and Regulations