Permission to Publish Personal Information

I , do hereby affirm that I give The Shire of Falcon's Keep my permission to publish the
following contact information and data for official use of the group. If I should be come an
event steward or officer of the group, I am obligated to supply my information in accordance
with the duties of the position held. If there should be any changes of my information in the
future, I shall resubmit a new form with such changes noted upon it.
Modern Name:
Permission to use on
Newsletter / Directory or Website
 SCA Name:
Address:
Phone:
Email:
My Web
page:
Present Offices:
Awards/Orders:
Persona:
Interests/Talents:
# of active years in the Shire of Falcon's Keep:
Do you have a Membership card?
 Yes
 No
The shire has my permission to use
photographs of myself on it's website
and in official publications
 Yes
 No
Submit sends and returns you to the Members page.