Why do you want to attend the Hersir Program?
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Be very specific.
Norse Name (If Assigned)
Gender
*
Male is defined as YX chromosomes, and female is defined as XX chromosomes.
Legal Name
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First Name
Last Name
Date of Birth
*
MM
DD
YYYY
Father's First Name
*
Father's Middle Name
*
Email Address
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Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
Citizenship(s)
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Relationship Status
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With a male
With a female
No relationship
Children
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No children
1 child
2 children
3 children
4 children or more
Do you have a Criminal Record in any country?
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If yes, please explain
Are you an Active Duty or Reserve member of the Armed Forces of any country?
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If yes, please explain.
Are you a member of any law enforcement agency of any country?
*
If yes, please explain.
Discharge from the Armed Forces of any country?
*
If yes, please explain.
Released from a law enforcement agency of any country?
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If yes, please explain.
Involvement in any lawsuit in any country?
*
If yes, please explain.
Diagnosed with any health condition?
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If yes, please explain.
Diagnosed with any mental condition?
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If yes, please explain.
List your injuries:
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If applicable
List your prescription medications:
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(If applicable)
List any current or past drug use, including marijuana:
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(If applicable)
List all your social media accounts:
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Including personal and business accounts you manage or have access to, across all platforms.
Other Affiliations
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List all other organizations you are a member of, whether officially or not.
Do you hunt?
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If yes, please provide details with respect to frequency, species harvested, weapons used, hunting grounds, etc...
Do you fish?
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If yes, please provide details with respect to frequency, species harvested, method used, fishing areas, etc...
Do you raise livestock?
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If yes, please provide details with respect to extent of operation, type, etc...
Do you engage in physical exercise?
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If yes, please provide type, frequency, location, etc...
Where do you live?
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What do you drive?
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Make, model and year.
What are your hobbies?
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Be as specific as possible.
How do you spend your free time?
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Be as specific as possible.
Do you drink alcohol?
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If yes, please provide type, volume and frequency.
Do you smoke?
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Do you use any other type of nicotine products?
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If yes, please explain.
Do you drink coffee on a daily basis?
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Do you gamble?
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Do you have any other addiction?
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If yes, please explain.
Skills
Provide a list of your verified skills
Message/Notes
Certification
*
