Full Name *

The name you wish to be called if different from the above

Address *

Email *

Phone Number *

Date of Birth *

Gender Identity *

Your path/tradition *

Occupation *

Educational qualifications to date Or
Life experience you feel should be taken into consideration *

Reasons for taking this course and how you see this fitting into your future goals *
(continue in notes below if necessary)

Please supply two references

Name and address of someone who follows your Pagan path, and who has known you for at least a year *

Name and address of someone who has standing in the community, not necessarily a Pagan, but who has known you for 5 years *

I confirm that I accept the terms and conditions of the Pagan Seminary and all the information supplied is correct *

Fields marked with * are required

Optional Notes

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