Application for Membership of the 137th N.Y. Co. F

Full Name:

Street:

City: State: Zip:

What type of reenacting do you wish to do? Military / Civilian / Musician

Home Phone: ( )

Work Phone: ( )

Optional - Employer will be contacted only in the case of an extreme emergency

Emergency Contacts:

1. Name: Phone: ( )

2. Name: Phone: ( )

Yes No : I have received, read, and understand the bylaws.

Yes No : I have never been convicted of a felony.

Yes No : I have filled out my medical form and will keep it on my person at all times.

Yes No : I am over 18 years of age.

Under 18 years of age must have the signature of a parent or legal guardian

_________________________________________________________	_______________
Member's Signature	Date
_________________________________________________________	_______________
Parent/Guardian Signature (If under 18)	Date

Families: Please fill out a separate application for each member