SCA College of Svatý Sebesta
Student Registration Form

Please Fill out the following information by printing legibly:

Required Information:
Information contained in this section is used by the Collegium to maintain Registrar and Attendance records. It may be made available to other SCA entities through published Reports or on the Collegium's web site.

SCA Name:  __________________________________________________________
Local SCA Group: __________________________________________________
SCA Kingdom: __________________________________________________
Have you taken classes within the Collegium prior to registering today?  Yes ___  No ___

If yes, under what name(s) did you take these classes?
__________________________________________________
__________________________________________________
Optional Information:
Information in this section may only be used internally within the Collegium.
Mundane Name: __________________________________________________
Mundane Address: __________________________________________________
__________________________________________________
__________________________________________________
Phone: (    )  __________      E-mail Address: _______________________________

Check here if you would be interested instructing a class or workshop.  _____

To Be Completed by Collegium Staff
Date Registered: ____________       Registered by: ______________________________
Date Received by Registrar:  _______________
Date Entered:  __________ by  _____________________________________________
Confirmation Mailed to:   ___  Student      __  Chancellor      __  Local Group

Form Revision Date: March 24, 2002