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| 155th Pennsylvania Volunteer Infantry Company H Reenactor Membership Application NAME: __________________________________ ADDRESS: ________________________________________ ________________________________________ PHONE: ________________________________________ EMAIL: ________________________________________ Will you have any dependents reenacting with you? ( Y or N ) _______ WIFE/SIGNIFICANT OTHER NAME: _________________ Insurance? ($10.00) ________ Do you have any relatives that have served during the CIVIL WAR? ( Y or N ) ______ If yes, do you know which unit and company? UNIT ________________________ COMPANY _______ References: Do to the nature of using weapons and Gun Powder, we ask that you provide three references. (Note: Any information collected through your references will be kept highly confidential and only be used for membership purposes.) NAME PHONE RELATIONSHIP ________________________ _________________ ________________________________ ________________________ _________________ ________________________________ ________________________ _________________ ________________________________ Currently, there is a $10.00 yearly fee per member that must accompany all applications. Make initiation fee check payable to the 155th Pennsylvania Vol. Inf. Company H. Mail application and fee check to: Yvonne Whipple Treasurer 2414 Eastern Ave Wesleyville, PA 16510 Thank you for your interest in the 155th PVI Co H. |