Mundane (Real) Name:___________________________________________________
Address:_______________________________________________________________
City:_____________________________ State:___________
Farspeaker (Phone #):__________________________________________________
Date of Birth:____________________
Full Persona Name:
________________________________________________________________________________
________________________________________________________________________________
What Group or Company are you with (If applicable)?
________________________________________________________________________________
Persona Information (Race, Nationality, Odious Personal Habits,
etc):___________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
I agree to release and hold harmless Amtgard, Inc, Kingdom of Goldenvale,
Shire of the Forgotten Crossroads, Amtgard Splinter chapters, and all members of
all Amtgard Chapters from and against all claims, demands, and actions in
respect to damage to my person or property arising in connection with my
participation in Amtgard functions. Furthermore, I accept and understand that
neither Amtgard or any Amtgard member is responsible for any injuries received
or given at any Amtgard function.
________________________________________________________________________________
Signature
________________________________________________________________________________
Signature of parent/guardian (if person is a minor, under 18 years of age)
________________________________________________________________________________
Date