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English Civil War Society of America
Membership Form

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.
Signature: ________________________________________Date:____________
Sponsor: __________________________________________Date:____________
Regiment/Unit: _____________________________________________________