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.
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 this will make it impossible for others to contact you via the website. |
| 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:
Lady Krystene of Blatha an Oir
Krystene of Blatha an Oir
6707 35th ST CT W
University Place, WA 98466
When you have completed the form, click the "Submit" button.
Lady Krystene of Blatha an Oir
Krystene of Blatha an Oir
6707 35th ST CT W
University Place, WA 98466
When you have completed the form, click the "Submit" button.
