Petition for Land Grant

Group Name: ___________________________________________________________

Group Contact Information: (you must choose a memeber of your group to act as a Liaison to the RGK for any matters concerning your Land Grant.)

Primary Contact:
Name: _______________________________________
Phone Number: _______________________________________
Secondary Contact:
Name: _______________________________________
Phone Number: _______________________________________

Please circle only one of the available answers.

Type of Group: Company Household
Type of Parcel: New Land Grant Land Grant Addition

Please describe your sedired location using existing Land Grans as points of reference:

___________________________________________________________
___________________________________________________________
___________________________________________________________
For RGK Use Only: Date:____________
Group Type Approved: YES NO CORRECTED
Reason: _____________________________
Condition: _____________________________
Parcel Type Approved: YES NO CORRECTED
Reason: _____________________________
Condition: _____________________________

Qualifications: Registered with Amtgard, Kingdom of the Emerald Hills?    YES    NO
Existence of > 6 months?    YES    NO    If no, when eligible: ____________________
Minimum 150 Kingdom Work Hours completed as of: ____________________

Land Grant approved and finalized:____________________
Parcel #: ____________________
RGK Secretary Initials: ________

FORM: Land Grant Request
Ver. 1, Rev. 1
Page 1 of 1 12/13/00