Society Name	
+ 	Name being submitted
	(if different from above)	

Name Type (pick one)
	Primary
	Alternate +
	Household +
	Other (specify) +

_____________

Action Type 
	New
	Resubmission ++
		Kingdom
		Laurel	
	Change+, if registered:
		release old name
		retain as alternate
	Change of 
	Holding Name +
	Appeal (attach justification)                     
	Other (specify)   
______________

Legal name	 
Address		
	
Branch Name	Gender of Submitter		M		F
Phone Number	Date of Birth	
E-mail Address	Date Submitted			
Consulting Herald	Herald's E-mail/Phone	
++ 	Name(s) previously submitted 
but not registered (if any)	
++	Kingdom submitted from: 	++Date returned: 	
Name processing criteria. Read these carefully. Laurel may need to make changes in order to register the name.
MAJOR changes include: adding/dropping a name element, changing an element’s language, changing the order of elements.
MINOR changes include: accents, punctuation, hyphenation, addition or deletion of a letter, upper-lower case changes, etc..
	I will NOT accept MAJOR changes to my name, even if the name cannot be registered without such changes.
	I will NOT accept MAJOR or MINOR changes to my name, even if the name cannot be registered without such changes.
Note: Leaving both boxes blank indicates that you will accept both major and minor changes in order to register your name.
If my name must be changed, I care most about:		meaning		sound		spelling		language and/or culture
(Please specify "meaning", "sound", “spelling” or "language and/or culture" desired)	
The desired gender of my name is:		male		female		don't care
[OPTIONAL] Please CHANGE my name to be authentic for:	
Please be specific, e.g. '12th-14th century' or 'Irish' or ‘Welsh’, rather than saying 'early' or		language and/or culture
'late' or 'Celtic'.  Please do not select this option if you do not wish changes to your name.		time period
If you are, or will soon be, submitting another item (such as a device, badge, or household name):
If the Laurel Sovereign of Arms finds that your name cannot be registered for any reason, and you do not already have a name previously registered, Laurel may create a "holding name" for you so that your other item can be registered. This holding name will be treated as your registered name until you register an acceptable name. There is no fee for changing a holding name.
	I will NOT allow the creation of a holding name. I understand that if my name submission is returned, then my other submission(s) will be returned as well.
Name Documentation and Consultation Notes (attach additional sheets and documentation as needed.)