site logo

1st Pennsylvania Artillery

Membership

Type of Membership: Single_____ Family_____

Date of this application: _______________20____

Please fill out entire application:  Enclose with one years' dues ($25.00 for single
membership or $50.00 for a family membership). Make check payable to Cooper's Battery B.
If family membership, please list spouse and any dependents, in same household as applicant,
on reverse. Include Dates of Birth , and signatures. If membership is not approved, you will
receive a full refund of dues. Cooper's Battery B is a section 501(c)3 nonprofit corporation.

Name:______________________________ Date of birth:________________

Address:_______________ City:________________ State:___ Zip:_________

Phone:_______________ Cell:_______________ Email-________________

Employed By:_________________________ Employer's Phone:____________

Have YOU (or Spouse/dependents if applicable) ever been convicted of a crime?

Yes___ No___ If yes, explain for anyone applicable.___________________

_______________________________________________________________

Were you referred by someone? Yes___ No___ If yes, Name:_______________

Are you a member of another Civil War Reenactment Group? Yes___ No___

If yes, what group? ________________________________________________

Reason for wanting to join this organization:_____________________________

________________________________________________________________

Character Reference:

Name:____________ Address_________________________ Phone:________

Applicants Signature:______________________________________________

If under 18 years of age you MUST have a parent or guardian as an active
member of Cooper's Battery.
Parent/Guardian's Signature: ________________________________________
Providing any false information will lead to immediate dismissal from Cooper's Battery.
In signing this application, you agree to absolve and release Cooper's Battery B of any
and all liabilities for personal injuries, theft, or accidents of any kind.

Return to: Scott Debo, 144 Race Street, Sunbury PA, 17801
Questions call: Scott 570-286-8997 OR Dennis Dewalt 570-648-3001
Or email:scottdebo@hotmail.com Or Dennis ddewalt@ptd.net