Copy-and-paste this form, rather than printing it with all of the extraneous content around it.

SCA Name (registered or submitted)	Item Type (name/device/badge)	Check Number
1. ____________________	______________________	________
2. ____________________	______________________	________
3. ____________________	______________________	________
4. ____________________	______________________	________
5. ____________________	______________________	________
6. ____________________	______________________	________
7. ____________________	______________________	________
8. ____________________	______________________	________
9. ____________________	______________________	________
10. ____________________	______________________	________
Consulting Herald: _______________________________
Notes for Golden Dolphin: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________