1) Your Screen Name:

2) Full Name:

3) State CSoR Guild or Freelance# and your dice:

4) Your GC's SN(void if Freelance):

5) Reason for wanting to be a Healer:

6) Combative or Non-Combative (mark one):

          Combative [ ]

          Non-Combative [ ]

Once completed send to VGiselleV