Action Type
	New
	Resubmission
		Kingdom
		Laurel	
	Change, if registered:
		release old device
		retain as badge
	Appeal (attach justification)                     
	Other (specify) 

This name is (pick one):
	already registered
	submitted with this device 
	previously submitted from the Kingdom of

Society Name	 
Legal name	
Address	
	
Branch Name		
Phone Number	Date of Birth	
E-mail Address	Date Submitted	
Consulting Herald	Herald's E-mail/Phone	

If using any restricted charges, please give Kingdom and date of eligibility for that charge.

Proposed Blazon  (Consult a herald if possible.  Use plain English if you don’t know how to blazon.)

Blazon as submitted on LoI 
(Kingdom Use Only)

Instructions: give 1 color and 1 uncolored line drawing copies, plus 1 copy of supporting documentation to your local herald with a check made out to "SCA, Inc. - [local group name]" OR send all to the Saker Herald (name and address available at the Saker Herald (name and address available at the Saker Herald's website: http://heraldry.calontir.org/saker.htm) with a check made out to to “SCA, Inc. Kingdom of Calontir - Heralds".

(Note: the shield shape should be approximately 5 inches (12.7 cm) wide and 6 inches (15.2 cm) tall when printed)