Permission to Publish Personal Information

I, _______________________________, being known in the Society for

Creative Anachronism, Inc., as ___________________________________, do

hereby affirm that I give the    Guild of Withie and Woolmongers    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:_____________________________________________