Midwest Living History Association

Membership Application

Name____________________________________________________

(last) (first) (M.I)

Address__________________________________________________

(Number) (street) (apt. #)

___________________________________________________

(city) (State) (zip)

Phone (_____)_____________________ Email ________________________

Date of Birth _______/_______/_______

1^st Unit___________________________________________________

(Unit Name) (War or era) (Nationality)

2^nd Unit___________________________________________________

Medical conditions __________________________________________

(note to minors)

All minors must have Parents Approval. Minors participation in certain events

will be approved on an individual basis.

Parent Signature_________________________ Date________________

By signing this I state that I will follow all M.L.H.A. rules and conduct myself

in a respectful manor.

Applicants Signature_____________________ Date ________________

Make check payable to M.L.H.A. Membership $ 15.00

Mail to:                                         

(Your Squad's                      OR                M.L.H.A. 

Unit Commander ) Alan Watkins - Secretary

13345Waverly Rd.