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10th Kentucky Volunteer Infantry
Application for Membership
Directions: Please PRINT legibly and initial ALL blanks on back of form. One form per family member.
Name: ____________________________________________________
Address: ____________________________________________________
City: ___________________________ State: _____ Zip: __________
Home Phone: ____________________ Work Phone: _________________
Birth Date: ________________ Age: ______
Emergency Contact: _____________________________________________
Type of Membership: (circle all that apply)
(New) (Trial Membership, single event, one time only) (Individual Membership)
(Family Membership) (Other)
Number of persons in family membership: ________
If NEW application: Any previous reenacting? (Yes) (No)
If yes, name of Organization: ________________________________________
Do you have any physical or medical conditions restricting your activities?
(Yes) (No)
If yes, please describe: ______________________________________________
_______________________________________________________________
Email address: ____________________________________________________
FOR MINOR APPLICANTS – Must Be Signed By Parent or Legal Guardian
“I _________________________, the Parent/Guardian of the above named minor, have read and understand the above statements and do hereby give permission for him/her to participate in all aspects of reenactment activities.”
Signed _________________________________ Date ___________________
Phone _________________________________________________________
Legal relationship to minor: __________________________________________
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