First Name:

Surname: (only first letter if you don't want to write full name)

Pseudonym

Birth date:  

Gender: man woman

City/State or Province:

Country:

Native Language:

Other Language:  

Main Activity:

Last Educational Level Completed: middle_school high_school college Masters_Degree Other

Where did you find out about Leblandia?

Why do you want to became  Leblandia's citizen?:

Write something about you, your hobby, your job...

My email will be published on Leblandia's webpage Agree NO

I want to became a citizen of Leblandia YES NO

Your surname will not be published, if you don't want: please publish my name please publish only first letter

How active do you plan to be in Leblandia Affairs? not active at all frequently active increadibly active very active

ESSAY: Tell us what you expect from the Empire of Leblandia, and your life in Leblandia. Especially what kind of work you would like to do, what kind of place you think Leblandia should be, and how you intend to make It a better place.
(Essays with less than 5 lines will not be considered. This is the most important part of the Citizenship Form. Please think before you submit it.) 

Comments? Questions? Write here...

THANK YOU. This form be analyzed by Consul. Your e-mail address will be added to our Yahoo-Group. Press Submit Button to send this Form.