Declaration Against Witchcraft Form

Declaration Against Witchcraft Form
Please complete this form to formally declare your position regarding witchcraft. All information is required for the purpose of this declaration only.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Residential Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Date of Declaration
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Are you making this declaration of your own free will?
Have you ever participated in or been associated with any witchcraft practices?
Declaration Statement
Reason for Declaration (optional)
Signature
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Should be Empty: