APPLICATION FOR Vivaldian CITIZENSHIP

Welcome to the Republic of Vivaldia! To apply for citizenship, please submit the

1) Please tell me your name: (Do not hit return)

2) Please tell me your email address: (Do not hit return)

3) Where do you want to live?

4) Which political party do you wish to affiliate with?

Indicate if other: (Do not hit return)

5) If you hold citizenship in another micronation, where? (Do not hit return)

6) Where did you hear about Vivaldia? (Optional) Do not hit return

7) Any comments? (Do not hit return)

Thank you for becoming a citizen of Vivaldia. We look forward to seeing you on our national scene!