FIELDS MARKED WITH * ARE REQUIRED

*Name (Nicknames are fine):
*Email:
*Birthdate: *Date of Application: *Date joined YahooGroup:

*What do you identify as (fey, therian, vampire)?

*Which Shades currently interest you the most? (For an explanation of the Shades, see here
Crimson Ebon Dusk Lapis Snow

What are your interests or hobbies?

What, if any, fields or areas of magical/occult study have you pursued?
Have you ever had any formal magical/occult education? If so, where and how much?
On a scale of 1-10 (1 being lowest), how would you rate your experience in magic/occult?	1 2 3 4 5 6 7 8 9 10
What factors have led you to seek membership with House Rosa?
Please tell us briefly about yourself

*If you are accepted, what what you like your members-only site access login information to be?
*Username: *Password:
Do you wish to have an @houserosa.org eMail address? Yes No
Would you prefer to have a separate mailbox or an address forwarder?
Mailbox
Forwarder (What address to forward to? )

or