The Fraternal Order of
House DevnoH
Membership Application
Date
of Application _______________________
Human Name _________________________________________________________
Address _____________________________________________________________
City ___________________
State _______
ZIP _____________
Date of Birth
___________________ Phone ______________________________
Email Address
_________________________________________________________
Klingon Name
_________________________________________________________
Fan Groups you belong to (check
all that apply)
__K.A.G. __U.F.P. Local
Klingon Klub ______________________
__U.F.P.I. __Other Local
Feddie Club ________________________
__KLAW __I.F.T.
__The
Federation __Starfleet
CONTACT
INFO
Send Completed
Application to:
House Proctor:
Captain QatanI' sutai-DevnoH
aka: Dr. Tony Roberts
2813 Pine Meadow Drive
Marietta,
GA 30066
(you may copy & paste this into an email and
send to the Epetai or Proctor’s email address, see
contacts link for email contact info.)
Information
Upon your acceptance of
initial application,
You will be contacted
concerning the one-time
Payment of a $6.00 initiation fee along
With membership
expectations and character
Storyline
requirements. Like KAG, we share
The “Prime
Directive” to HAVE FUN!
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