MEMBERSHIP APPLICATION FORM

AP F,LIC.ATI$* .IN F,ORIUATI

GI*

Before You Start - About This Application

Please complete all sections of this application form as fully as possible. lncomplete or incorrectly finished application
forms may cause delays in processing. Please ensure personal information is provided in its fulland complete legalform
as it would appear on government-issued documents. lnformation provided on this application is kept confidential and not
shared with unnecessary third parties. Please allow a minimum of 2 weeks for processing. Applicants will be notified by
their group leader or the membership thegn once their applications have been processed. Please fill out a membership
form for each person wishing to join. By completing this application you hereby agree to the general terms of membership
for The Vikinqs - Vinland as indicated below.
Application Submission :
Membership Fees:
Felag Mailing Address:
Fully completed applications may be submitted in any
of the following ways:
153 Woodhaven Drive
US Resident $35.00
- Electronically scanned as an email attachment to
CAN Resident $50.00
Okotoks, Alberta
Junior Member $1.00
Canada TISlLB
vinland.mem bership@gmail.com
Fees must accompany this application and
You will be contacted by
are non-refundable. They may be paid by in
- ln person at a Vikings Vinland Local Group Meeting
either the Membership
the cunency of the country you reside in by
- Via regular post to the mailing address indicated in
Thegn or the Jarl to
the use of www.PAYPAL.com to
the space to the right:
confirm your application
vikingacanada@yrhor.ca sr payable
'and chat with you briefly.
directly to your local group ieader if
- A clear passpoii type photo is requrreci for lD cards
applicable.
and may be submitted electronically
GON'TACT HFORtdATIOt'l

Futt Lesat Last

Name

R.oeqv s

Fun Legat First

Name [:'lrt"i3i'

J.r,ure

Date of
Birth

Street Address / Legal Land Description

St-l

Middle

DD

Month Y Y YY

oB

o5 /? 8c

Mailing Address (if different than street address)

Prrr,a Da LvE

City / Town

ProvincelState

Postal or

(abbreviated)

ZIP

Home Phone

CellPhone

Number

Number

uccuPatlon

l"lql &x,l

Oxt

T6aosrrr>

code

Work Phone
Number

bt+1- ?,35- 14719

Fax Number

Co

SJS.,

LT

nfuT

EmailAddress (ensure you can access

yahoo groups with this)

IC(or-Av5

@.

ho*rv"o, | " cor-,

MEMBERSHIPS - Are you a member of any other reenactment society? Do you have qualifications from that
Do you have dependent children (under 18) wishins to ioin - List their information here.

MEDICAL INFORMATION

This information is only used in case of emergency i.e.: allergic to bee stings

Do you have any medical conditions of concern related to any of the following areas? (select all that apply)

!
!
I

E Ears

!
Hands
E Hips !
Respiratory E Asthma !
Eyes

voice

Neck

Back

E Shoulders E

Arms

Legs

Knees

Feet

Joints

Heart

nllergies

Rrtfrritis

Nerves

other

Please list any other medicalconditions you may be

effected by

or

N/A, no other
conditions

.86,o

Do you have current first aid

training?

(run

! Yes DFtlo

SKILLS AND INTERESTS

What areas of activity are you interested in the most?

./

ECombat KCostuming tr Authenticity ltiving

-. .^-r i^r^-^^r^
^r.ir^ and
you. Lhave
interests ..^.
I Please list any relatedu skills

History

Exhibit KCrafting

Other

Please list any related clubs you belong to or experience

yo-r-n"r"

Please list any

i you
have

public speaking or perforrning

experience

S \uc\r5 S\cr4-*x..I\

+1a1{6l1'e1atn

please list any portrayals you are interested in

-(a'YY1c+Llia

\ t q ,.).ar> i}-\j,1-- :$ai.nlf4nhut'l

Plead6 provide a brief syhopsis oTyoui inierest in joining (attach extra iheet if needed) .

Craft,ru; (t"bto-t u:ecu',irg + c-o)tL'r-rtr,/)r'r Iet*Ler- uce'rf-)

Fc.,r,it";

\in

c.ctiorlq

APPLICANT DECLARATION
I declare that the information provided on this form is true, correct, and complete to the best of my knowledge. I also
aqree to all oeneral terms of Membershio of the Vikinos Vinland.

Leader
Signature
Group

/h-./

Signature of Applicant (type name if

submitting electronically)

qrL-." #LA*-

Application

YY

Month

Date

q')

o\+

EXECUTIVE USE ONLY

Member

Number
Jarl Authorization

Classification

Notes

Acceptance
Date

Month Y Y YY

hrltlmEndlli{ltErffitt

M
MEMBERSHIP APPLICATION FORM

APPLICATION INFORMATION
Before You Start - About This Application
Please complete all sections of this application form as fully as possible. lncomplete or incorrectly finished application
forms may cause delays in processing. Please ensure personal information is provided in its full and complete legal form
as it would appear on government-issued documents. lnformation provided on this application is kept confidential and not
shared with unnecessary third parties. Please allow a minimum of 2 weeks for processing. Applicants will be notified by
their group leader or the membership thegn once their applications have been processed. Please fill out a membership
form for each person wishing to join. By completing this application you hereby agree to the general terms of membership
for The Vikinqs - Vinland as indicated below
Membership Fees:
Application Submission :
Felag Mailing Address:
Fully completed applications may be submitted in any
of the following ways:
US Resident $35.00
153 Woodhaven Drive
- Electronically scanned as an email attachment to
CAN Resident $50.00
Okotoks, Alberta
Junior Member $1.00
Canada Tl51L8

vinland.membership@gmail.com
- ln person at a Vikings Vinland Local Group Meeting
- Via regular post to the mailing address indicated in
the space to the right:
- A clear passport type phot': i:; required for lD cards
and may be submitteci electro,rrcally

You will be contacted by

either the Membership
Thegn or the Jarl to
confirm your apolication
and chat with you briefly

Fees must accompany this application and

are non-refundable. They may be paid by in
the clirrency of the country you reslde in by
the use of ww,tr.PAYPAL..com to

vikingscanada@y:riioo.cd

I oir".[y m vorrticat
I applrcable

gr,.,r,,'

.'

frayabie
,-:ader-ii

r_

I CoNTACT TNFORMATTON

j Full Legal Last Name

Full Legal First Name

FullLegal Middle
Name(s)

Street Address / Legal Land Description

I city I lown

Home Phone
Number

Province/State
(abbreviated)

Cell Phone
Number

Work Phone
Number

Dateof D D
Birth /

Month

YY

Mailing Address (if different than street address)

Postalor
ZIP Code

Fax Nunrber

Occupation

Email Address (ensure you can access

yahoo groups with this)

YY

MEfrIBERSHIPS - Are you a member of any other reenaetment society? Do you have qualifications from that
Societv? Do vou have denendent children (under I
to ioin - List their information here.

MEOICAL INFORMATI$N

This information is only used in case of emergency i.e.: allergic to bee stings

Do you have any medical conditions of concern related to any of the following areas? (select all that apply)

Ll

E Ears

Eyes

voice

Neck

E Knees
f uips ! Legs
! Respiratory ! nstfrma f, Allergies E nrtfrritis

Hands

Please list any other medicalconditions you may be

effected by

or

E Back E Shoulders E Arms

E Feet E Joints
! Nerves E Otrer
N/A, no other
conditions

fl run

Heart

fl

N/A

Do you have current first aid

training?

E-Yes E

ttto

SKILLS AND INTERESTS

What areas of activity are you interested in the most?

ECombat E Costuming

fl Authenticity ltiving

Please list any related skills and interests you have

History

Exhibit E Crafting E Ottrer

Please list any related clubs you belong to or experience

you have

Please lisi any portrayals you are interested

Please provide a brief synopsis of your interest in joining (attach ertra sheet if needed)
.l

APPLICANT DECLARATION
I declare that the information provided on this form is true, correct, and complete to the best of my knowledge. I also
agree to all general terms of Membership of the Vikinqs Vinland.

Group Leader

Signature of Applicant (type name if

submitting electronically)

Signature

Application
Date

//L^ ak r-

0 t

Month
,)

//

ot+

EXECUTIVE USE ONLY

Member

Number
Jarl Authorization

Classification

Notes

Acceptance
Date

DD

Month

Y Y YY

ffi ffi
MEMBERSHIP APPLICATION FORM

*F.,.F.hlATICINiIH ll
Before You Start - About This Application
Please complete all sections of this application form as fully as possible. Incomplete or incorrectly finished application
forms may cause delays in processing. Please ensure personal information is provided in its fulland complete legalform
as it would appear on government-issued documents. lnformation provided on this application is kept confidential and not
shared with unnecessary third parties. Please allow a minimum of 2 weeks for processing. Applicants will be notified by
their group leader or the membership thegn once their applications have been processed. Please fill out a membership
form for each person wishing to join. By completing this application you"hereby agree to the general terms of membership
for The Vikinqs - Vinland as indicated below.
Application Submission :
Felag Mailing Address:
Membership Fees:
Fully completed applications may be submitted in any
of the following ways:
153 Woodhaven Drive
US Resident $35.00
- Electronically scanned as an email attachment to
Okotoks, Alberta
CAN Resident $50.00
Canada T1SlL8
Junior Member $1.00

vinland.membenship@gmail.com

- ln person at a Vikings Vinland Local Group Meeting

- Via regular post to the mailing address indicated in
the space to the right:
- A clear passport type photo is required for lD cards
and may be submitted electronically

You will be contacted by

either the Membership
Thegn or the Jarlto
confirm your application
and chat with you briefly.

Fees must accompany this application and

are non-refundable. They may be paid by in
the currency of the country you reside in by
the use of www.PAYPAL.com to
vikingscanada@yahoo.ca or payable
directly to your local group leader if
applicable.

rl}Iro

Full Legal Last Name

C*^[.r

FullLegal First Name

FullLegalMiddle
Name{s)

Month
I

YY

Mailing Address (if different than street address)

ProvincelState
(abbreviated)

&eogzfou,^

CellPhone

Number

Number

/&

L1q &fcp

oNl

Home Phone

(e"s)-73- Ll?itt

Postal or

2iit;;

Work Phone
Number

Fax Number

NiA

Nia

occupation

Gsl", It*n. F**u"

EmailAddress (ensure you can access
yahoo groups with this)

qiq rnS - @ hJ,,a il . co.n

YY

tqqL

{e^7Lo- fu

City I Town

l(

L1

SL"

Oa-v\

Street Address / Legal Land Description

Date of
Birth

MEMBERSHIPS - Are you a member of any other reenactment society? Do you have qualifications from that
Do you have dependent children (under 18) wishinq to ioin - List their information here.

MEDICAL INFORMATION

This information is only used in case of emergency i.e.: allergic to bee stings

Do you have any medical conditions of concern related to any of the following areas? (select all that apply)

I Ears ! Voice ! Neck E Back E Shoulders E Arms

E Hands E uips ! Legs ! Knees E Feet E Joints
E Heart
! Respiratory ! Asthma I Allergies E Rrtfrritis ! Nerves E Ottrer EIUn
Please list any other medicalconditions you may be

or

N/A. no other
conditions

Do you have current first aid

x N/A

Yes Kruo

SKILLS AND INTERESTS

What areas of activity are you interested in the most?

pCombat ECostuminS EAuthenticity

f,Living History

Please llst any related skills and interests you have

Exhibit ffi Crafting E Other

Please list any related clubs you belong to or experience

you have

G,.';r..{.'*-1
Please list any public speaking or performing experience

you have

Please list any portrayals you are interested in

Please provide a brief synopsis of your interest in joining (attach extra sheet if needed)

fi:11''l:,,a ,

D',llr,."

."

.t,.rci

ifus.f;r.r

APPLICANT DECLARATION
I declare that the information provided on this form is true, correct, and complete to the best of my knowledge. I also

to all qeneral terms of Membership of the Vikinqs Vinland

Signature of Applicant (type name if

submitting electronically)

DD

Month

D(

lz-

D D

Month y y yy

EXECUTIVE USE ONLY

Mem.ber
NUmDer

Classification

Notes

Acceptance

MEMBERSH IP APPLICATION FORM

APPLICATION INFORMATION
Before You Start - About This Application
Please complete all sections of this application form as fully as possible. lncomplete or inconectly finished application
forms may cause delays in processing. Please ensure personal information is provided in its full and complete legal form
as it would appear on government-issued documents. lnformation provided on this application is kept confidential and not
shared with unnecessary third parties. Please allow a minimum of 2 weeks for processing. Applicants will be notified by
their group leader or the membership thegn once their applications have been processed. Please fill out a membership
form for each person wishing to join. By completing this application yo;r hereby agree to the general terms of membership
for The Vikinqs - Vinland as indicated below.
Application Submission :
Felag Mailing Address:
Membership Fees:
Fully completed applications may be submitted in any
of the following ways:
153 Woodhaven Drive
US Resident $35.00
- Electronically scanned as an email attachment to
Okotoks, Alberta
CAN Resident $50.00
Canada T1S1LB
Junior Member $1.00

vinland.membership@gmail.com
- ln person at a Vikings Vinland Local Group Meeting
- Via regular post to the mailing address indicated in
the space to the right:
- A clear passport type photo is required for lD cards
and may be submitted electronically

You will be contacted by

either the Membership
Thegn or the Jarl to
confirm your application
and chat with you briefly.

Fees must accompany this application and

are non-refundable. They may be paid by in
the cunency of the counky you reside in by
the use of www.PAYPAL.com to
viklngscanada@yahoo.ca or payable
direcfly to your local group leader if
applicable.

CONTACT INFORMATION
Full Legal Last Name

fu'{or-..

Full Legal First Name

Li"tr/s..*

Street Address / Legal Land

Lt

Lascslleg

Description

Bl

'1**r"*o

DD

Month

YY

a1
)t

(3(

tq q3

Mailing Address (if different than street address)

,,J a^Lioa

CellPhone

Work Phone

Number

Number

YcBoll+

Postalor

Zpil;

Occupation

M+v Zss A"tist

Ot.t

GVl

Date of
Birth

Alpxa*Jr." J^,^n

Province/State
(abbreviated)

City / Town

Home Phone
Number

Full LegalMiddle
Name(s)

EmailAddress (ensure you can access

yahoo groups with this)

Fax Number
I

,ndsirg

%t-r^A kol-,,rqip

1-4

YY

MEMBERSHIPS - Are you a member of any other reenac'tment society? Do you have qualifications from that
Do vou have deoendent children (under 181wishino to ioin - List their information here.

No
MEDICAL INFORMATION

This information is only used in case of emergency i,e.: allergic to bee stings

Do you have any medical conditions of concem related to any of the following areas? (select all that apply)

flryes

ears

voice

Neck

Back

E Shoulders E

Arms

Hands

Hips

Legs

Knees

Feet

n Joints

Heart

Respiratory

Rstnma

!
I

Attergies

Artnritis E Nerves

EIN/A

Please list any other medicalconditions you may be

effected by

or

N/A, no other
conditions

otner

Do you have current flrst aid

training?

n Yes El'trto

EIINN
SKILLS AND INTERESTS
What areas of activity are you interested in the most?

ElCombat El-Costuming

E{uthenticity

ECiving History

Please list any related skills and interests you have

Exhibit El-Crafting

W}mer

Please list any related clubs you belong to or experience

you have

J G'-

t-\b^o?tl*, n
Wc,rlr*p
Bt
[csr", l*ln i na, No"[{,r. *d ;r.r., l-t ev{.,"l lsr"^ Re \ i ,.\',-o r^
".c list any publiCspeaking or performing experience
Please
^,_
Please
list any portrayals you are interested in

you

p*1,..{.,.=

have

Il,^l+,.a 6 u .tJh",lt ()uohf,col,"6 Tneo#te-ScLo.l V.r\va,

Please provide a brief synopsis of your interest in joining (attach extra
slreet if needed)
-i+*--frt(s+--A;{sv\F

pc.ss;tt<,Ji^
+. "eJAft'-+to-'-V;[i^\ tiiz G
*Lt T ; Tx:;Lt' "x.rr *;' h,,,*(
.$'
t i l'{-[^o- Ll'.g{.<5}
F
1;L +cr
**
Sl.*^dqod Foss''tl-- .os..\} tq ;rc.Jbk
V,.f'""i", ti.Ce-

T1o r,ce'

o'btg

tr5'

Hil

APPLICANT DECLARATION
I declare that the information provided on this form is true, conect, and complete to the best of my knowledge. I also
agree to all qeneralterms of Membership of the Vikinqs Vinland.

Group Leader
Signature

4t*rlru.fl I

Signature of Applicant (type name if

submitting electronically)

erA

Application
Date

Month

2-z

Y Y YY

Lo

rq

EXECUTIVE USE ONLY

Member
Number
Jarl Authorization

Classification

Notes

3:?:o'"'* D D

Month Y Y YY

MEMBERSHIP APPLICATION FORM

APPLICATION INFORMATION

Before You Start - About This Application

Please complete all sections of this application form as fully as possible. lncomplete or inconectly finished application
forms may cause delays in processing. Please ensure personal information is provided in its full and complete legal form
as it would appear on govemment-issued documents. lnformation provided on this application is kept confidential and not
shared with unnecessary third parties. Please allow a minimum of 2 weeks for processing. Applicants will be notified by
their group leader or the membership thegn once their applications have been processed. Please fill out a membership
form for each person wishing to join. By completing this application you hereby agree to the general terms of membership
for The Vikinqs - Vinland as indicated below.
Application Submission:
Felag Mailing Address:
Membership Fees:
Fully completed applications may be submitted in any
of the following ways:
153 Woodhaven Drive
US Resident $35.00
- Electronically scanned as an email aftachment to
CAN Resident $50.00
Okotoks, Alberta
Canada T1S1L8
Junior Member $1.00

vinland.membership@gmail.com
You will be contacted by

- ln person at a Vikings Vinland Local Group Meeting

- Via regular post to the mailing address indicated in
the space to the right:
- A clear passport type photo is required for lD cards
and may be submitted electronically

Fees must accompany this application and

paid

are non-refundable. They may be

by in
either the Membership
the currency of the country you reside in by
Thegn or the Jarl to
the use of www.PAYPAL.com to
confrrn yourap$ieation- ".- vlklngscanada@yahoo.ca or payable
direcdy to your local group leader if
and chat with you briefly.
applicable.

CONTACT INFORMATION

FullLegalLast Name

Full Legal First Name

U^ll,s

f1^Iql,tw
Street Address / Legal Land Description
rc2

-3

tl

Date of
Birth

Sl^l"t icr^{l

DD

Month

YY

YY

c3

tc)

l1

61

Mailing Address (if different than street address)

Postalor

Province/State

(abbreviated)

.-

C,[oo L"N)

khh,",.
N/A

Name(s)

?a,tee- D.ra

City/ Town

Home Phone
Number

FullLegal Middle

CellPhone
Number

Work Phone
Number

f l1-focrSroi 5t\'wL10{

2ipil;
NL?

occupation

LL1 rL^.^7-\ f..*L {eJn,.'*n

Fax Number

EmailAddress (ensure you can access

yahoo groups with this)

'r",1|;r^^*fE1@

yol ' c','\

MEMBERSHIPS - Are you a member of any other reenactment soclety? Do you have quallfications from that
Do you have dependent chlldren (under {8) wishinq to ioin - List their information

Ill*llk,

?.o\,*"nt

MEDICAL INFORMATION

5urri.Shrll,

- Thls informatlon

is only used in case of emergency l.e.: allergic to bee stlngs

Do you have any medical conditions of concem related to any of the following areas? (select all that apply)

E Ears

flVoice D Neck
ffiacx flShoulders flRrms
I Hips ! Legs ! Knees I Feet n Joints
flHeart
flRespiratory ! Asthma flAllergies E Rrtnritis I Nerves I ofirer
flrura

n Eyes
fl Hands

Please list any other medical conditions you may be

effected by

lyc.lrrl

L.cL

or

^^gle| - ml,nut' &Nr6x:ttt.

l.l/A, no other
conditions

Do you have cunent first aid

training?

EA-n

fl Yes Efo

SKILLS AND INTERESTS

What areas of activity are you interested in the most?

6moat 6u^ng

Efffih-enticity

Please list any related.skills and intgrests you

''
tJrl** (k*''^,0 Gi" n^btCJ*uii'

A6**ory Exhibit 6o,nn

have \
'"a'o"r')

Please'list any public speaking or performing experience

you have

otner

Please list any related clubs you belong to or experience

you
n

have
d.J&nnKJ."t

".,
portrayals
you are interested in
Please list any

|'r*Lrs,^,

-U^W, *1,^"-7!:f:Yn,
Please provide a brief.synopsii of ypur intereqt in ipining (attach extra sheet if needed)
's),c^lro, ,,"1
t1;>i-1.
L
fl2',o\51:-l*," ,* fr6\ {hr'.,1h Lrrri'rr5
Iu
p*v
l;[ceu
I
p,Y
I uo,ll hL.I, h *bte{o ie*n 4 4r"re l^*-bd5e- J ll.- pi"l'

frluhl*^

APPLIGANT DECI.ARATION
I declare that the information provided on this form is true, conect, and complete to the best of my knowledge. I also
agree to all general terms of Membership of the Vikinqs Vinland.

Signature of Applicant (type name if

submittlng electronically)

Group Leader
Signature

//Lz-.2t14/

Application
Date

Month

Y Y

aa

tt

l o

DD

Month Y Y YY

EXECUTIVE USE ONLY

ffifffl
Jarl Authorization

chssification

Notes

$cceotance

|k&,ldlL{SEETM

MEMEERSHIP APPLICATION FOBM

AppltcAxolt tHFonitATlolt
Belore You Slarl - About This Application
Please complete all seclions s{ this application {orrn as fully as possible. lncomplete or incorrectly tinished application
forms may cause delays in processing. Please ensure personal informalian is provided in its full and complete legal lorm
as it would appear on Eovernment-issued documents. lnlormation provided on this application is kept confidential and not
shared with unnecessary lhird parties. Please allow a minimum o{ 2 weeks for processing. Applicants will be notiiied by
their group leader or the membership thegn once their applications have been processed. Please iill out a membership
fon* ior each person wishing to ioin. By completing lhis application you hereby agree to tha geileral lerms ol membership
for The Vikinos - Vinland as indicated below.
Applicaiion Submission:
Felag Mailing
ii&smbership Fees:
Fully completed applications may be submitted in any
153 Woodhaven Drive
US Resideni $35.00
of the lollowing ways:
- Eleclronically scanned as an email atlachment lo
okotoks. Alberta
CAN Besident $50.00
Canada T1S'1LB
Junior Mernber $'1.00
vi nland. nremb*rs hip@gmai l.com
Fees rrusl accompafiy this application arrd
You will be contacled by
are non-relundable. ?hey may be paid by in
- ln person at a Viking$ Vinland Local Group Meeling
either the Membership
thle currency o, lhe country yor reside in by
- Via regular post 10 the mailing address indicaled in
Tlregn or the Jarl to
the use oi wvrw.PAYPAL.com to
confirm your applicalion
i'ikingscanada@1ah*o.ca or payable
th* space ta the right:
diratly ta your locai !irup ,eader il
- A clear passport type photo is required for lD cards
and chat with you brie{ly.
applrcaUe.
and may be submitied electronicaily
COHTACT ItlFQffMlTICIl*

FuliLegalLast Name

Fr.rll Leqal First Name

Full LegalMiddle

Nameis]

Oale of
Birth

Street Address'/ Legal Land Description

Mailing Address (il dilferent than street address)

City lTown

Postalor
Zip

Horne Phone
Numbar

il;

Cell Phone

Work Phone

Number

Nurnber

Fax Number

YY

occupation

EmailAddress {ensure you can access

yahoo groups with this)

YY

illEMBgR$tllPS - Ar* you a rnemher *f any olher rsenaclrn*nl sqci*S? Do you kav* qualilicstions fism thal
181rsi*}tins ls isin - Llst Iheir inlorrration here.
$ocl*tv? So vcu haw
child:en

HEDICAL IIIFORIilATIOH

-Thi$ irlurmation is unly usad in ca*a of emergsnsy

i.e": alleruic

lq bee

Do you have any medical ccndilions o{ ccncern related to any of lhe lollowing areas? {select all that apply}

[] Eyes
I ears f, Voice I Neck f Back il Shoulders f Arrns
ff Hands I Hips I tegs f, Knees f Feet I Jolnts I Heart
fl Respiratory tr asfrma fl Allergies I Rrttrritis tr Nerves il Otner n NiA
Please list a*y other medical csnditions you may be
effected by

Do you have current firsi aid

training?

lrllA, no olher
ccnditions

U Yes Lf'No
-/
SKILL*

ASIT} FTTENESTS

What areas of activity are you interested in the most?

Costuming fi.Authenticity Iliving

Hislory

Exhibit tr Cralling

Bdtn*n

Please list any related clubs you belong to or experience

Please list any relaled skills and interests you have

you have

Flease list any lrublic sp*aking or performing experience

you have

Please llst any po*rayals you are inleresled in

a brief synopsis ol your interest in joining {atlach exlra sheel if needed}

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AFPI.ICAilT NECI.ARAITOI.T
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declare thal the in{onnation provided on this lorm is trus, conpat" and complate to the best oi my knorarledge. I also
ree lo all ceneralterrns o{ Mernbershin oi the Vikincs Vinland"

$ignalur* of Applicant (type name ii

submiting el*ctronically)

Group Leader
Signature

EXECUTI$T U$E O}.'LV

Member

llumbsr
Jarl Autharizatjon

Classilication

Notes

Acceptance
Dete

DD

Msnth

YY

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MEMBERSH IP APPLICATION FORM

APPLICATION INFORMATION
Before You Start - About This Application
Please complete all sections of this application form as fully as possible. lncomplete or inconectly finished application
forms may cause delays in processing. Please ensure personal information is provided in its full and complete legal form
as it would appear on government-issued documents. Information provided on this application is kept confidential and not
shared with unnecessary third parties. Please allow a minimum of 2 weeks for processing. Applicants will be notified by
their group leader or the membership thegn once their applications have been processed. Please fill out a membership
form for each person wishing to join. By completing this application you hereby agree to the general terms of membership
for The Vikinqs - Vinland as indicated below.
Application Submission :
Felag Mailing Address:
Membership Fees:
Fully completed applications may be submitted in any
of the following ways:
153 Woodhaven Drive
US Resident $35.00
- Electronically scanned as an email attachment to
Okotoks, Alberta
CAN Resident $50.00

Canada T1S1LB

Junior Member $1.00

You will be contacted by

either the Membership
Thegn or the Jarl to
confi rm your application
and chat with you briefly.

Fees must accompany this application and

are non-refundable. They may be paid by in
the cunency of the country you reside in by
the use of www.PAYPAL.com to
vikingscanada@yahoo.ca or payable
directly to your local group leader if
applicable.

vinland,membership@gmail.com
- ln person at a Vikings Vinland Local Group Meeting
- Via regular post to the mailing address indicated in
the space to the right:
- A clear passport type photo is required for lD cards
and may be submitted electronically
CONTACT INFORMATION
Full LegalLast Name

t-/^^ Oirk

TA5t^ -t

Street Address / Legal Land

&/

L,-

City / Town

Tobvta
Home Phone
Number

Full LegalMiddle
Name(s)

Full Legal First Name

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hl'|.

Ot.*

Number

Work Phone
Number

(.511) b1,9"''7ff1

aL{

Month Y

tt

Y Y

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Mailing Address (if different than street address)

Province/State
(abbreviated)

CellPhone

of

vurl

Description

Lct|c5

Date
Birth

o5
Postalor

2'';;;
mLt/ *bg
Fax Number

occupation

fiCo(tn-Y4 I

fJto*-E9u{t<,t

Email Address (ensure you can access

yahoo groups with this)

l no rbi

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MEMBERSHIPS - Are you a member of any other reenactment society? Do you have qualifications from that
Do you have dependent children (under 18) wishins to ioin - List their information here.

MEDICAL INFORMATION

This information is only used in case of emergency i.e.: allergic to bee stings

Do you have any medical conditions of concern related to any of the following areas? (select all that apply)

fleyes

E ears

fl Voice

Neck

Hands

dmo,

fttegs

Knees

Respiratory flAsthma

E Feet E Joints
E Nerves E otner

! nllergies E Rrtnritis

Please list any other medical conditions you may be

effected by

or

Back n Shoulders n nrms

!
I

Heart
N/A

Do you have current first aid

training?

N/A, no other
conditions

{*,o

f]Yes n ruo

SKILLS AND INTERESTS

What areas of activity are you interested in the most?

dCombat dCostuming dAuthenticity

Please list any related skills and interests you have

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dw,z-^t<,( a-.cf..
a lo cr,ty

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Please list any public speaking or performing dxperience

you have

17r/ S-X/ Tq**rcc

ilcratting

drrrrnnHistory Exhibit

otner

Please list any related clubs you belong to or experience

vou have

'""uli,- J

yo

$ia-ct"Tqo,an ( a'lucT{a"5
Q 1,.lorur^t^

Pc-Ol)

Please list any portrayals you are interested in

c.L-(r5

Please provide a brief synopsis of your interest

'iiz;'in joining (attach ext;a sheet if needed)

'?-"T;"--ix;;d;'"*;"I;-+i'L yr.,te5f L[*z^* YoeEiitra

T.wotttd rir. lo (<cra-#
[t. Qcolth4r ot d1N favt7
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c-'6(?'.' l- +oeorfa:i (rt $,4 cy eell b eLlal oqc*rcrzat6e, Tzc\rilarwS .

APPLICANT DECLARATION
I declare that the information provided on this form is true, conect, and complete to the best of my knowledge. I also

to allgeneralterms of Membership of the Vikinos Vinland.

Signature of Applicant (type name if
submitting electronically)

DD

Month

s*7

tr

EXECUT]VE USE ONLY

Member
Number

ficceptance

Y Y YY

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