Recruit’s Name: ___________________________________________________________

LAST MIDDLE FIRST

Recruit’s Street Address___________ ________________________________________

NUMBERS STREET NAME

City _____________________________________________ State _____Zip___________

Home Phone ________________________ Cell Phone ____________________________

Recruit’s Membership ………....................Quantity1 …X…$10 = ……..$ 10

Recruit’s Spouse………………………… Quantity ___X…..$5 =……....$_____

Recruit’s Children Age 12 and above: ….Quantity ____X…$5=…..……$_____

Membership Cost Total = $______

for membership and Liability insurance. I wish to join the following branch of service

or Re-enactor’s group: Artillery ______Cavalry ______Civilian ______Infantry _______

Dismounted Cavalry_____

Spouse Name________________________

Children names:______________________

___________________________________

Unit Designation:  Porter's Battery

Unit Commander:  Capt. Jimmy Steppee

Form last up dated 2/5/2011

Submit this form to your nearest recruitment

station or address your application to:

Attention Recruitment dept.