Membership Application

Name:_______________________________________________________                         (First)                  (Middle Initial)                    (Last)

Address:_____________________________________________________                                        (Number and Street)

_____________________________________________________________                          (City)                        (State)                            (Zip Code)

Phone:_______________________________________________________

(Home)                   (Cellular)                           (Other)

E-Mail: ______________________________________________________

Primary Interest: (Check One)

[   ] Military (Men Only)            [   ] Both (Men Only)

[   ] Civilian (Men or Women)

Type of Membership: (Check One)

[   ] Individual                            [   ] Family

I heard about the 17th Michigan from: (Please Check One)

[   ] Recruiter    [   ] Website    [   ] 17th Member    [   ] Periodical

[   ] Other (Please Specify)____________________________________________

Please indicate how you wish to be contacted:

[   ] E-mail                                                                [   ] U.S. Mail

[   ] Phone  (specify number)__________________________________________

Optional Information:

Age: ____________Occupation:__________________________________

Level of knowledge about the American Civil War:

[   ]  Excellent       [   ]  Good      [   ]  Moderate          [   ]  Low

Special interest or objective in Civil War Re-Enacting and/or Living:

History:______________________________________________________

_____________________________________________________________________

_____________________________________________________________________

 Please mail your application to:

17th Michigan Regiment, Company E, Inc.
P.O. Box 530071
Livonia, MI. 48153-0071

or

E-Mail your application to:

Recruiter_17thMich@msn.com

In return, you will be contacted either by phone or mail (your option).

Thank you for your interest in the 17th!

Note: You can copy the application by:

1)  Holding down the left button on your mouse and highlight the application.    (Note: The application is formatted into a table to make it easier to copy).

2) Click on the right button and select copy.

3) Press Minimize Button  [_] located on the upper right of the screen to remain connected to the internet and the 17th Website.

4) Open your word processing software,  (i.e. Microsoft Word), to a blank page.

5) Place cursor on your blank document, click the right button and select paste.   Now you have a copy that you can print!

6) Place cursor on the Request Information  window located on the bottom right of your screen, and click the right button on your mouse to return ( Maximize) to the 17th Website.

After you have a  copy of the application, you can complete the form and copy & paste the completed application to your e-mail message to us, or print a copy and send it via U.S. mail.

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