Your Full Name (required)

Preferred Name (if applicable)

Your Email (required)

Cell Number (required)

Date of Birth (required)

Postal Address (required)

Website

Gender FemaleMale

Education level (required)

Occupation (required)

Do you have any learning disabilities? YesNo

What special skills or areas of study are you proficient in? (required)

What are your interests or hobbies? (required)

What are your other pagan or religious affiliations? Which other groups or organizations do you belong to (required)

Other information about yourself that you would like to share with us (optional)

In 25 words or less, why do you want to be an Outer court Member? (required)

Do you agree to support and follow the beliefs and practices of the Correllian tradition regardless of your other teachings, beliefs, practices, or affiliations? YesNo

Are you willing and able to maintain an active involvement with the Correllian tradition, and work collaboratively and cooperatively with other members of the Tradition and the Administration? YesNo

I have re-read all that I have written and agree that it is all accurate to the best of my belief and understanding. YesNo

Please add a copy of your ID card / Social Security Card / Passport: