Excelsior Republic citizenship form
OUT OF DATE, PLEASE CONTACT US ON OUR WEBSITE INSTEAD.

www.excelsiorgov.org


Please note that this information is being collected, processed, and stored. It is under the protection of Excelsioran law and shall never be shared with any other third parties.

Once received, you may expect a response within 10 days.

If you are not contacted within 15 days, please email chancellorofexcelsior@gmail.com.
Email *
What language(s) do you speak? 你会说什么语言？ ¿Qué idioma hablas? तुम कौनसी भाषा बोलते हो? Quelle langue parlez-vous? *
What is your name? (Full name, please.) *
What is your date of birth? *
MM
/
DD
/
YYYY
In which country were you born, and in which state/province/territory/oblast? *
Is this where you currently reside? *
If not, where do you reside? *
Please select all that apply: *
Required
Do you agree that Excelsior is a sovereign nation? *
Please list all macronational citizenships you hold. *
Please list all, if any, micronational citizenships you hold.
if you are a citizen of a micronation, do you hold a government position there? *
If so, please name the position.
What gender do you identify as? *
how often do you check your email address? *
Which political party would you like to register as? *
Which state/territory/SAER would you like to be a citizen of? *
Do you promise to be a faithful, cooperative citizen? *
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
Google Forms