Outer Court Application
Temple Applying To: Correll Mother Temple(USA) Selu Temple (USA) Sedna Temple (Europe) Clan of Kheper Temple (Africa) Your Email Address: Legal name: Craft name (optional): Instant Message address and domain (optional): Home address: Mailing address (if different): Primary phone number (please specify type): Alternate phone numbers (please specify type): Web page (Optional): Gender: Date of Birth:
Member of Temple, Shrine, or Study Group
Have you ever been convicted of or arrested for any crime? If so, describe fully and provide dates, location, and disposition:
Occupation: Education level: Disability (optional):
Pagan affiliations (groups, projects, awards, etc.):
Special skills or areas of study (magickal or otherwise):
Hobbies and Interests:
Other information about yourself that you would like to share with us:
I am at least 18 years old Yes No Are you willing and able to maintain an active involvement with the Correllian tradition, and work collaboratively and cooperatively with other members of the tradition and the administration? Yes No Do you attest and affirm under penalty of law that all of the information provided in this application is true and correct? Yes No
Short Personal Bio. 500 word Max.