Annual Dues: The annual dues are payable immediately upon or prior to the first event attended. Membership and Insurance Coverage is good for the remainder of the calendar year.
Individual $25.00 Husband/Wife $40.00 Family $40.00
Membership Application / Annual Dues
Amount:________________
ALL members must fill out this form in its entirety to have full Insurance Coverage.
Name: __________________________ SSN: _________________________
Name: __________________________ SSN: _________________________
Name: __________________________ SSN: _________________________
Name: __________________________ SSN: _________________________
Name: __________________________ SSN: _________________________
Address: __________________________________________
__________________________________________
Email: ____________________________
Phone: _______________________
Make checks payable to: Fifth Pennsylvania Regiment
Mail to (or bring to Membership Meeting):
Joanne Godzieba, Treas., 5th PA
1351 Woodbourne Rd.
Langhorne, PA 19047