Dark River's Personna and Permission to Pulish Form
Accolades to St. Carol on the Moore for the Loan of this form.

Middle Kingdom policy required that we obtain written permission to publish certain personal information about our members. Please use this form to indicate which information you are giving permission to publish. You may include as much or as little information as you like. Please do not leave any blank lines - place and "X" on any line you do not wich to have published (Note that SCA Name, heraldic devices, titles, awards and offices held may be published without permission).


I,                                                                                                    , being known to in the Society for Creative Anachronism
as                                                                                                 ,do hereby affirm that I give Dark River permission to publish the following information about me, at the discretion of its officers, both in print and on the internet:
SCA Name:
Modern Name:
Address:
City: State: Zip:
Phone:
Email Address:
Title(s) and Awards:
 
 
Activities and Interests:
 
 
Persona Culture:
Persiona Period:
Persiona Bio:
 
 
 
 
 
 
 
 
 
 (If Very Extensive, Please provide Web Mistress with Electronic Copy)
Brief Mundane Bio:
 
 
 
 
I hereby grant permission to puclish photographs of me, my encampments,
my equipment or other personal property              (Initial)
Signed Legal Name and Date Here: