Enlistment Form

Name:

Address:

Apt#:

Town/City:

State:

Zip Code:

Phone Number:

E-mail:

Date of Birth:

Month:

Day:

Year:

Example: 1981

Required :

Required:

Required:

Required:

Required:

Experience

Military:

Reenactor:

Required:

Unit:

Battalion:

Membership

Type:

Individual Membership of $20.00 to cover one year insurance, due upon acceptance.

Family rates differ uppon number of participants

Comments:

All Rights Reserved 2004-2006 Lee's Light Horse Inc.

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NO

FamilyIndividual