ARIZONA CIVIL WAR COUNCIL INC

Membership Application

Name ___________________________________________________ Date __________________

Address ________________________________________________________________________

City ___________________________________ State _____________ Zip Code _____________

Telephone _____ - _____ - _______ Date of Birth * (if under 18 years) _____/_____/_____

Applications under 18 years must have had prior joint discussion with parents and ACWC

council member regarding ACWC Inc’s responsibility as well as written consent of parent

Unit you are submitting application for: 1^st U.S. Infantry _____ 1^st Texas CSA Infantry _______

Artillery: US ___________ CSA _________ Civilian __________ (Other desired) _________________

Any medical condition which may be necessary for someone to be aware of for your safety.

(will be kept confidential within unit NCO staffing): Allergies, regular medications, asthma, etc..

________________________________________________________________________________________

Marital Status: Single ______ Married ______ Divorced ______

If application is for other than yourself for membership: list their names and desired units.

(if children, list their ages) no weapons will be carried under 16 years old.

Name ___________________________________________ Unit _________________ Age ________

*** Please do not purchase any military uniforms or equipment without contacting you unit N.C.O.’s

first, to avoid unnecessary purchases that may not be authorized by your units impression.

Dues structure is for: Council Dues & Insurance (different for Armed participation and Unarmed)

Signature ____________________________________________ Date ______________________

♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦DO♦♦♦NOT♦♦♦SEPERATE♦♦♦OR♦♦♦CUT♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦

Date of application _________________

Unit clerk submitting application _____________________________ Unit _________________

Dues payment : Cash $ _____________ Check # _____________ Amount $ _______________

If mailing application mail to: A.C.W.C. Inc. 3748 W. Mercer Ln.

Phoenix, AZ 85029

Date Received by Council Treasurer _________ Initials ______ Council Secretary _____________

Appendix B

MEDICAL FORM

This form should be carried on person and on file with Commander

Form should be updated as needed.

Name __________________________________ Social Security No. __________________ Age ___________

Address ___________________________________________________________ D.O.B. ________________

Phone __________________________________ Blood Type (if known) __________________ Sex ________

Doctor’s Name ____________________________ Phone __________________________________________

Next of Kin ______________________________ Phone ____________________ Relation _______________

Insurance Company ________________________ Insurance No. _____________________________________

Allergies (list all – i.e. to medicine, food, plants or animals): _________________________________________________

_________________________________________________________________________________________

Health problems (list all – i.e. heart, respiratory, blood pressure, asthma, diabetes or any other): _____________________

_________________________________________________________________________________________

______________________________________________________________________________________________

Medicine taken (please list name, dosage and how often): _______________________________________________

_________________________________________________________________________________________

Place where you keep your medicine while in camp: ___________________________________________________

_________________________________________________________________________________________

Do you have a Living Will? If so where? ___________________________________________________________

_________________________________________________________________________________________

I hereby give all Doctors, Nurses, or other Emergency personnel my permission to give all reasonable treatment to me if I’m

not capable of giving my permission. If I am under the age of 18, my parents give permission for me to have all reasonable

treatment until they can be reached.

_____________________________________________________ ____________________________________

Name (Signature) Date