Full Government Name
Tribal Name
*
Birthdate
Email
*
Phone
*
Tribal ID #
Tribal Affiliation
Desired Kingdom Trust Name
*
Alternative Kingdom Trust Name
*
Kingdom Trust Company Mailing Address
*
City
*
State
*
Postal code
*
List any desired colors you would prefer for your family seal
*
Are you apart of any other groups or organization?
*
What services do you plan to provide through your kingdom to members of the Empire?
Signature
*
Clear
Today's Date
*
Submit
