INTERNET APPLICATION FORM

The American College of Heraldry
A Non-profit Corporation Established 1972
1643-B SAVANNAH HIGHWAY, SUITE 396, CHARLESTON, SC 29407

PLEASE NOTE

____ I am applying for both Membership and Armorial Registration ($350)

____ I am applying for Membership only ($39.95)

____ I am applying for Armorial Registration only ($325)


PLEASE TYPE OR PRINT, AND FILL OUT ALL ITEMS COMPLETELY
Title(s): ie Mr, Mrs, Dr, Rev, The Hon, Lt Col, etc: ____________________

Name:__________________________________________________________________________
      First		  Middle		Last	       Maiden Surname

Address: ______________________________________________________________________
	    Street		     City	            State           Zip    

Telephone: ________________ Email: ____________________________________________  

County (not Country): _______________________________

______ I am requesting the College to design a new coat of arms for my personal      
       use and to Register and Publish the same.
______ I am requesting the College to Register and Publish the coat of arms I  
       now have which has not yet been granted, registered, certified, or      
       otherwise recognized for my personal use by a domestic or foreign office 
       of arms.
______ I am requesting the College to Register and Publish the coat of arms I 
       now have which was (  )granted, (  )registered, (  )certified, 
       (  ) otherwise recognized for my use by the following office(s) of arms.

       _____________________________________________________________________

______ I am enclosing information verifying this armorial recognition.

______ I am not requesting a Registration of Arms at this time.


The Armiger's News will be sent to members in PDF format
on or about the 1st of January, April, July, and October


Date of Birth: ___________________ Date of Legal Adoption: ____________________

City, County and State of Birth: _______________________________________________

Marital Status: (  )Married; (  )Never Married; (  )Widowed; (  )Divorced;  

(  )Other _____________________________________

Sex: (  )Male;  (  )Female

Education:  Institution    Degree/Certificate		Major Subject	   Date
 
________________________________________________________________________________

________________________________________________________________________________
 
________________________________________________________________________________

Present Occupation(s), Position(s), Profession(s): 
Please attach a business resume if available.





Military Service: (  )Army; (  )Navy; (  )Air Force; (  )Marine Corps; (  )Coast Guard; 
(  )State Military Service

List highest rank held and major decorations received:



Public Office: (List offices held, past or present, by election or appointment. Clearly indicate 
whether each office is at City, County, State, Federal or other level. State dates when each office 
was entered and when each was vacated.)





List Membership in Organizations, Societies, Associations, Clubs, etc.:





List hobbies, avocations and interests:



List Orders of Knighthood & Nobiliary Associations (please include (a) the full name of the Order; (b) your rank in it; (c) your appropriate postnominals; (d) please enclose photocopies of certificates):



Full name of your Father:

_______________________________________________________________________________
First	 			 Middle				Last

List dates of his birth: ___________________     his death: ___________________

Full MAIDEN name of your Mother: 

_______________________________________________________________________________
First			       Middle	 	        Maiden Surname

List dates of her birth: ___________________     her death: ___________________


List full name of your Spouse: 
_______________________________________________________________________________
First			       Middle	                Maiden Surname

List dates of her birth: ___________________     her death: ___________________


Children born to or adopted by you and the above named spouse:

          Full Name	     		 Sex              Date of Birth     Date of Adoption        Alive?
(ex) John Lea Jones        		Male             7 June 1971         10 July 1971             yes

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________
NOTE: Should you have any children whatsoever by previous marriages, it is VITAL that you enclose full information on both children and their mother(s) as noted in the last question. Further, if this registration is for someone who is a grandfather, then include all eligible descendants (attach a separate page if necessary), such as all chidren of the armiger, as well as all of the children of those children. Please be sure to include MAIDEN names of any spouses as parents of additional children.

Please forward a separate sheet on any additional biographical data which you feel may be helpful.

I hereby certify that all biographical data contained in this application is accurate to the best of my knowledge.

______________________			________________________________________ 
Date					Signature

Please print out and mail this completed application, along with any of the applicable funds as indicated above. 

METHOD OF PAYMENT:

  ___ Check or Money Order made payable to THE AMERICAN COLLEGE OF HERALDRY

  ___ Visa    ___ MasterCard    ___ American Express    ___ Discover/Novus

 Card # _________ - _________ - _________ - _________   Exp Date ___________
 Your signature above indicates acceptance of credit card charges.

Copyright (c) 1996-2010 The American College of Heraldry
 
** Credit card billing offered as a gratis service to The American College of Heraldry by Gryfons Publishers. 
Credit card statements will reflect charges from GRYFONS PUBLISHERS