Name: _________________________________________________

      Address: _________________________________________________

 City/ST/Zip: _________________________________________________

 e-mail address: ___________________________
      
     Date of birth: ______________

            Health: _________________________________________

I hereby apply for membership in the 155^th New York Volunteer Infantry Reenactment Regiment, Incorporated. I understand that Civil War reenacting is a strenuous hobby and bad my level of participation is solely at my discretion. I will learn the safe use and operation of all items use by myself and the Regiment.

Signature: ___________________________

Parent's signature (if under 18): _________________________________   

*Annual membership: $20.00 ($40 per family: please attach copies of this form with additional names)
                               Total enclosed: $_______

Please complete form and mail, with check (payable to 155^th NYVI) to:

*Membership based on calendar year and renewal of membership fee is due by December 31. Membership includes subscription to the 155th journal, The Harp.

If you have any questions, please contact