Welcome to Exile Alliance Applicaton Form

Exile Alliance Membership Application Form

Your Real Name: *

Email Address (Primary Contact) *

In-Game Name *

Date of Birth: DD-MM-YYYY: *

Country and State/Province (ex, USA - California): *

Your Time Zone (ex, EST, PST, GMT): *

The Name of your Recruitment Liaison (Recruiter): *

Date Recruited: *

What PC Games do you currently play?: *

What Division are you Applying For? *

Do you have Teamspeak 3? *

Do you have a Condition that prevents you from using Teamspeak? *

Have you read Exile Alliance Code of Member Conduct (required)? *

Type the characters you see in the picture below