Request edit access
Citizenship Application (CA-04)
Please ensure to scroll to the bottom and click "submit" when completed.
This Form could have multiple sections. If it does click "next" to move on and so on until you can "submit"
Sign in to Google to save your progress. Learn more
Email *
Last Name *
First Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Country of origin/residence *
Current occupation *
Any qualifications *
Please allocate your Citizenship to a State for Registration purposes. *
What is your Ethnicity? *
What is your Primary Language? *
What is your Religion? *
How will you contribute to the Empire of Lehmark? *
By being a Citizen of Lehmark you agree to follow our laws and support the Empire until such time you are no longer a Citizen. Citizens of Lehmark are active and dedicated to their Empire. *
Oath of Loyalty to the Empire of Lehmark and to the Emperor and Autocrat *
All Citizens must join the Lehmark National Discord Server within 14 days of Approval; or your Citizenship will be Revoked. *
*As per Imperial Decree XXVII. - Discord Serer invite link - https://discord.gg/CySTzbPhbE
Membership in the Lehmark Order of Citizens will be provided upon joining our Discord Sever and having been verified by the Emperor and Autocrat. *
Please supply the Invoice/Order Number from your Citizenship Processing Fee Invoice, *
Pay via PayPal - https://py.pl/1vJ0Zg
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy