Palmetto Soldiers Relief Society

www.psrs-csa.com

Membership Application

If you need a copy of this application please email us and request one.... or copy and paste this page and print out your own copy...

Palmetto Soldiers Relief Society

Application for Membership

NAME:

 

 

E-Mail:

 

ADDRESS:

 

 

HOME PHONE:

 

CELL PHONE:

 

WORK PHONE:

 

Birthday:

 

SPOUSE:

 

 

Spouse’s Phone:     Cell #

 

 

Children:

(names, ages, & birthdays)

 

 

 

 

Emergency Contact:

 

Phone: Relationship:

 

 

Insurance Company:

 

Group #            ID #

 

 

Doctor’s Name:

 

Phone:

 

Briefly Describe any Medical Condition/Allergy, Medications, etc.

 

Briefly Describe special talent, skill or knowledge you are willing to share:

 

By signing below I agree to abide by the By-Laws, standing orders and safety regulations of the Palmetto Soldier’s Relief Association and the Palmetto Battalion in order to accurately portray the women of War Between the States Era. I will actively support and enhance the authenticity of the PSRS and the Palmetto Battalion by preserving and perpetuating Southern History and Heritage

Applicant's Signature: ___________________________________________________date______________

Unit Representative's Signature:____________________________________________date______________

Unit Affliliation_________________________________________________________________________

Please mail application and $15.00 Dues to:

Lynn Dukes

Secretary, PSRS

118 Hope Drive

Summerville, SC 29485

Your membership in a Palmetto Battalion's Unit must be verified before you may have all the privileges

 of the new membership year.  If you submit this form without having you Unit Rep. sign it, then it must

be varified. Please include a contact name in the field above to help us expedite this for you.

2009-2010 Unit Reps

Unit Reps:
Sandy Sharpe - 15th SCVI
Maria Shull - 14th SCVI
Louise Murray - 11 SCVI
Sherry Key - 25th SCVI
Kathleen Harris - 8th SCVI
Carla Dorn - 13th SCVI
Pat Blitch - SCLA
Lekena Ackerman - 20th SCVI
Lee Bryant - 27th SCVI
Lynn Dukes - Black Oak