If here you click\nthen lost you will be.\nGo not here. Outlands Chirurgeons' Guild

Submit or Update a Roster Entry

Please enter your contact information and certification expiry dates in the form below.
Your SCA name, mundane name, branch, chirurgeonate rank and Email address1 will be displayed in the roster. All other contact information is only accessable to the Kingdom Chirurgeon and deputies.
Note 1: Email addresses are stealthed and cannot be harvested from our website by spam-bots. If you still feel you do not wish to have your Email address displayed, please leave the primary address blank and enter your contact address it in the "Alternate Email" field. Note that will make it impossible for others to contact you via the website.

Why are you filling out this form?

Society Information
 Title:  Society Name:
 Branch:  Membership #:
 Rank:  Position:
Mundane Contact Information
 First Name:  Last Name:
 Address:
 City:  State/Province:
 ZIP/Postal Code:    Country
 Primary Email:  Alternate Email:
 Primary Phone:  Alternate Phone:
Certification Information
Please note that the total size of all of the attachments may not exceed 15,398 Kbytes.
 First Aid: / /  FA Attachment:
 CPR: / /  CPR Attachment:
 Membership: / /  SCA Attachment:
 Cert. Type  (e.g. Standard First Aid, Advanced First Aid, First Responder, EMT, etc.)
 Comments:

In order to comply with BoD requirements, physical copies of your credentials must be on file with the Kingdom Chirurgeon before your warrant can be indicated as active in the on-line roster. Please provide copies of your First Aid (or Equivalent) card, your CPR card, and both sides of your SCA membership card. If you have copies of your Certifications as a digital image (.gif, .jpg, .bmp, etc.), you may attach them using the attachment boxes in the above form, Otherwise, please mail the copies to:

THLord Conal Mac Nachtan
c/o William J. Knight
P.O. Box 1147
Los Alamos, NM 87544


When you have completed the form, click the "Submit" button.

Viewable with ANY brower!    Valid HTML 4.01!    Valid CSS!    Rated by SafeSurf    ChildSafe International Web Sites