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Membership Application

C-Company, 9th Regiment
United States Army Infantry

(Please print)

Street Address:

Day Phone:  (      )
Night Phone:  (      )
Email Addess:

General Health & 
Medical Concerns:

Emergency Contact:

Other Living History &
Re-enactment experience:

Signature:_______________________________________________ Date:________

Signature of Parent or Guardian if age 16 to 17

__________________________________________________________ Date:_______

Yearly Dues are $5.00- per calendar year (January 1 to December 31)
Send form to:
Charles R. Casada
8515 So. Cowan Road
Muncie, IN.  47302

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