|
Membership Application for Adult Memberships
expire Dec. 31st.
Washington Civil War Association
Adult Membership Application Form
(Ages 18 and over)
| Name: |
Birth date: |
| Address: |
Home Phone: |
| City: |
|
| State: |
Zip Code: |
E-Mail Address: |
| q Renewal orqNew Member |
q Individual Membership $25.00/yr. or qFamily Membership $ 40.00 / yr. List Family Member
actually Paying the dues _______________________
Each individual family member must complete a WCWA
application. Make checks
Payable to WCWA |
| Choose One |
Choose One |
| qUnion or qConfederate |
q Military Persona or qCivilian Persona |
| Unit Requested:
__________________________________________________________ |
| Sutler Name of Establishment:
____________________________________________ Type of Sutlery:
________________________________________________________ |
| Medical History:
Please list any medical conditions, that your unit commander should be aware of in case of
an emergency. _________________________________________________________________ ____________________________________________________________________________________
Person to contact in case of emergency _______________________________________
Relationship: ________________________________ Phone: _____________________ |
CHOOSE ONE
q I will access The Dispatch from the WCWA
web site. or
q I want to receive a printed copy of The
Dispatch by regular mail.
( The Dispatch is a monthly news journal published by the
WCWA ) |
I hereby acknowledge that I am fully aware of the nature and purpose of the activities
of the Washington Civil War Association (WCWA). I understand that these activities are
potentially dangerous, and I voluntarily accept any risk involved. I agree to be bound by
the rules and policies of the WCWA, and to obey the direction of the governing officials
at WCWA events.
Signature of Applicant______________________________________ Date:
______________
| For WCWA Official Use: Unit
Assigned to: _______________________________________________ Date: _____________________
Accepted by WCWA Unit Commander: _____________________________ Date:
_____________________
WCWA Dues Paid: ___________________________________________ Date: _____________________ |
| Received by WCWA Treasurer
______________________________ Date: ___________________________ WCWA Dues Received: q Individual $25 q Family $40 Paid under
_________________________________ |
This application must be submitted to your unit commander before you may
participate in any WCWA event. |