Application for Membership /
Engage the Unit for a Special Program

  Anyone who is interested in joining the regiment or engaging us for a special program, please print out this form and fill in the requested information. Then, mail it to the address shown at the bottom of the form. The regiment will review your information and contact you.

____ I want to learn about joining the regiment

____ I want to engage the regiment for a special program

          What type of program______________________________________________

          ________________________________________________________________

Please complete the following information:

1. Name: _______________________________________________________
2. Address: _______________________________________________________
3. City: ________________________________ State: ____ Zip: _________
4. Telephone: (______) _______-__________ (Home) (Work)
5. E-Mail Address: ________________________________________________

   For potential recruits only:

6. Age:_________
7. Skills and/or any previous reenacting experience:
   
   
   
8. Why do you wish to join the Loyal American Regiment?
   
   
   

Please Return this form to: