Jedi Gatherings Group

Jedi Chapter Member Application Form


If you have any questions or concerns, please contact Moonshadow or Jedi Xhaiden by using the "Contact Us" form found on the home page of the website.

(Questions marked with an * are required.)




  Today's Date
     


Background Information

  Online Handle(s)
     


  *Real Name (First and Last)
     


  *Preferred Name or Nickname (what name you prefer to be called in real life)
     


  Gender

     Male
     Female


  Age
     


  *Birthday (Month/Day/Year)
     


  *E-Mail Address
     


  Street Address
     


  City/Town
     


  *State/Province/Territory
     


  Zip Code
     


  *Country
     


  Home Phone Number            Cell Phone Number
              


  YIM
     


  AIM
     


  MSN
     


  ICQ
     


  Skype
     


Chapter Member Information


  *Chapter(s) to which you are applying
     


  Please list below any skills, lessons, or teachings you feel you can share with fellow Chapter members. (Chapters are designed for people of all levels, so if you do not feel ready to share anything at this time that’s ok. But also keep in mind that you each person is unique and most likely has something new they can bring to the group, even if they don’t feel as advanced in other areas.)
     


  If applicable, please list your qualifications for the items listed above.
     


  Please list any subjects, activities, or areas of study you are interested in focusing on in the Jedi Chapter.
     


  Physical resources you may be able to provide or share with fellow Chapter Members (dojo, sparring equipment, kendo sticks, etc.)
     


  *By submitting this application, I ascertain that I meet the necessary age requirements for the Jedi Chapter. (18 or older for a regular Jedi Chapter. Under age 18 for a Junior Chapter member.)

      Agree
      Disagree


  *I give consent for the background information listed above to be shared with the Chapter Leader of the Chapter to which I’m applying. (This information will be used only to ensure age eligibility and to assist with notification of future Chapter meetings.)

      Agree
      Disagree