EPOC

Enchandra Pagoda Of Conjur Gem Application

Please let us know how you heard of us:

Social Media

Referral

Google

Signage Other

Applicant's Full Name

Have you ever used another name(s)? Yes / No If yes, name(s)

Driver's License #: State Date of Birth

Date

Primary Phone #

Type

Secondary Phone #

Type

E mail Address

example@example.com

Have You or anyone applying been charged or Convicted of a felony Charge? Yes/No

-0-13

Have You or Anyone Applying been Diagnosed or Suffers from Mental Illness? Yes/No List any other persons/Spouse/ Children etc who will be applying with you below: Are you or any other applicants a member present of any Covens, Tribes, groups, or Safe Havens and have you in the past? Yes/No

Please list the name of the tribe and the owner

NAME

AGE_

RELATIONSHIP STATUS?

HOW MANY CHILDREN BIOLOGICALLY?

Do you, or any of the people who will be residing in this unit do street drugs? Marijuana Or Psychedelic NOT INCLUDED ? Yes / No

No

If you do use Psychedelic, please list them and the affects they have on you?

How do you feel you can contribute to

Why do you want to be a part of

Why do you want to be a part of Enchandra?

Do you understand that being a member requires dedication and is not based only on when you're

that being a member requires dedication and is not based only on when you're

What are some skills that you have that you feel you will be able to bring to

What are some skills that you have that you feel you will be able to bring to Enchandra?

What is your understanding of what Enchandra means and what it stands

What is your understanding of what Enchandra means and what it stands for?

Do you understand that you are making a covenant with Enchandra if you are approved?

that you are making a covenant with Enchandra if you are

We do readings etc not hexing a member over Pity issues and to make sure you are being honest with the

How do you feel about readings being frequently done on you to make sure you're

We do readings etc...How do you feel about readings being frequently done on you to make sure you're not hexing a member over Pity issues and to make sure you are being honest with the counsel?

Do you have any special needs or requirements that we need to be aware of? Yes / No If yes, please be specific:

Name of nearest living relative

Phone

Relationship

Who should we contact in case of an emergency?

Phone:Relationship:

Initial

Current Address

City

State:Zip:

City

Previous Address #1

City

State:

City

Initial

State

Zip

Signature

The Temple Of Invoking

HOW MANY CHILDREN ARE NON-BIOLOGICAL?