Name (please print) __________________________________________________

Spouse/Children (if joining) ____________________________________________

Address _______________________City ____________ State _____Zip ________

Phone _________________________ Cell Phone ___________________________

Email ___________________________Medical Info _________________________

Please check one.

______ 6th Kentucky Infantry, Co. C                              ______ Civilian

6th Regiment Kentucky Volunteer Infantry, Company C, Inc. is not responsible for damage to or loss of personal property or personal injury.

I have read and agree to abide by the Unit guidelines.

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