Second Wisconsin Volunteer Infantry Association Incorporated Membership Application Form

Name___________________________________________________________________

Address_________________________________________________________________

City____________________________ State________________________ Zip_________

Phone____________________ Fax____________________ E-Mail__________________

Date of Birth_______________________ Age________________ ( If under 18 years)

Social Security Number (Optional):_______________________________

Emergency Contact Name:__________________________________________________

Phone____________________________________________

Company Mustered into:______________________________(Optional)

Membership _____ Full _____ Family _____ Associate

Dues received: $___________________

Recruited By:________________________________________ Date:_____________

I, the undersigned, state that I am a United States Citizen and that I have never been convicted of a Felony.
I also understand that should I ever be convicted of a felony, my membership in the Second Wisconsin Volunteer Infantry Association, Incorporated will be immediately terminated. I understand that if I am between the ages of twelve to eighteen, I must provide a copy of my Hunters Education Certificate along with a written permission slip to join from my parent or guardian. In addition, I understand that The Second Wisconsin Volunteer Infantry Association , Incorporated is in no way responsible for any injury, dismemberment, disability, or death incurred during activities that I attend as a member of the Association. I also agree that The Second Wisconsin Volunteer Infantry Association, Incorporated is in no way responsible for any personal property lost, stolen, or damaged during activities that I attend as a member of the Association.

Signature ______________________________________________________

Date_________________________________________

SWVIAT Form 1 (03)

Membership Dues:
All below receive Regimental Newsletter
Full Membership $20.00
Family membership $20.00 (One Newsletter per Family)
Associate Membership $20.00 ( Non Military-non voting)

Make out check to:
Second Wisconsin Volunteer Infantry Association Inc.
Please send your check to and membership information to: 

Association/Corporate Secretary
Dave Sielski


 DSIELSKI@greenbay.gannet.com

 

Information subject to change at Yearly Regimental Meeting