|English Civil War Society of America
|Please print all info completely. Info will be kept confidential and on file for purposes of Liability Insurance or for emergencies only.
Last Name: ______________________ First Name: _________________ MI: __
Address: ____________________________City: ________________ State: ___
Phone: (Home)__________________ (Work)__________________ ZIP: _____
E-Mail: _________________________ Date of Birth: ___/___/___ Sex: ____
Employer: _______________________ Occupation: _______________________
If under age 18, please provide the following information:
Parent/Guardian: _______________________ Relationship: ______________
Address: ____________________________City:________________ State:___
Phone: (Home)_________________ (Work)___________________ ZIP: _____
First Aid Qualification: ________________ Firearms Licenses:________
Allergies or Medical Conditions: ___________________________________
Position within the organization (Check one):
Pikeman: ___ Musketeer: ___ Drummer: ___ Ofc/Sgt.:___ (rank:_________)
Trooper: ___ Trumpeteer: ___ Artillery: ___ Sutler: ___ Campfollower: __
I hereby agree to follow the rules of the ECWSA as outlined in its constitution (By-laws). I will place myself at disposal of officer(s) and/or official(s), and follow their instruction so long as they do not contravene any Federal, State or Local laws. I realize that the military aspect of the ECWSA may be dangerous and accept all risks thereunto, provided all reasonable safety precautions have been taken. I understand that I must dress myself in the correct and appropriate manner, and must equip and comport myself according to my position within the organization.
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