Permission to Publish Personal Information
I, _______________________________, being known in the Society for Creative Anachronism, Inc., as ___________________________________, do hereby affirm that I give the ________________________ permission to publish the following information about me on the Internet: SCA Name:_________________________________________________________ Modern Name:______________________________________________________ Address:__________________________________________________________ City:_____________________________ State:_________ ZIP:___________ Phone:____________________________________________ Email:____________________________________________ Web page:_________________________________________________________ Activities/Interests:_____________________________________________ __________________________________________________________________ __________________________________________________________________ Awards:___________________________________________________________ Signed this ___________ day of _____________, being _________ Gregorian. Sign legal name here:_____________________________________________
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