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Respublic of Lostisland

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If you want to become a citizen of Lostisland, please fill in this form. You are responsible for the correctness of filling this form. Applications for citizenship are considered personally by Captains Regent. Applications with invalid data will not be considered.
The Republic of Lostisland guarantees not to disclose your personal data information. It will be used only in statistical needs. If you want to recieve the Certificate of Citizenship, it will be send to the specified post address. Recieving the Certificate is paid and costs 5€. The purchasing makes by money transfer in the systems WebMoney or Moneybookers. If you want to purchase, we'll contact you to give more information.

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Place of birth *:
Place of residence (City) *:
Nationality *:
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Spoken languages (native first) *:
Do you want to recieve by mail the Certificate of Citizenship? *:
Why do you want to become a citizen of Lostisland? *:
Do you pledge to honour the laws and customs of the Republic? *:
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