Individual Application for Civilzenship
* Required field / + Preferred field
Other fields optional, though may be asked on future questionnaire

1. Name*
2. Street+
3. City   +    State/Province +   Country +  
4. Zip Code +

5. Sex  *
6. Age   +
7. Relationship status 
8. How many children do you have?

9. State of which you are a citizen *

10. To which Libercratic Government(s) do you wish to apply for civilzenship? *
Applying to Poliverium is an automatic application to Librademia also.
Applying to Valenturium is an automatic application to Poliverium and Librademia also.
   Librademia
   Poliverium
   Valenturium

11. (A) What is your level of education?  +
      (B) List of college degrees
12. What is your current employment?
13. Do you currently work for any political-state?  *
16. In what capacity do you work for the state? 
17. Are who willing to get contract insurance?  *
18. Are you willing to fully comply with the law of your chosen Libercratic government and abide by all regulations and responsibilities?  *

19. E-mail      * Please be sure and include your e-mail address
20. Telephone
21. FAX       
22. website   

23. Do you want to be added to the Libertocracy discussion group?

Thank you for your interest in becoming a Libercratic civilzen, we look forward to a mutually beneficial relationship.

    

Before completing the form please review the policies on civilzenship for Librdemia, Poliverium and Valenturium.

Completing this form is a pledge and an application for civilzenship, final civilzenship requires signing the constitutions and civilzenship contracts. 

There is no charge for becoming a Librademian civilzen. Civilzens only pay fees for the services they actually use and want. If you don't want a service, then you don't have to pay for it.

Civilzens are required to have Contract Insurance and are fully bound by the laws and responsibilities of their chosen government.

The cost of Poliverian civilzenship is explained in Poliverian Revenue which does not involve taxes or hidden charges, it only requires setting aside a portion of one's income and profits to be invested in  endowments, as well as user fees.

The costs and responsibilities of Valenturian civilzenship is explained in Valenturian Revenue.

Membership includes the monthly Libertocracy Association Newsletter with periodic updates, you can unsubscribe to the newsletter later if you want.

All information you give on this form, and in future communications, is kept completely confidential. It will be kept on record by the Libertocracy Association who will never under any circumstances allow this information to be given or sold to other parties, nor will it be voluntarily divulged to any state or its agents. The Libertocracy Association will take all reasonable security measures to insure that any information you give to us will be protected.