Print, fill in, and mail the form to:

Fred Klink
11th US Cavalry Regiment (Commemorative)
PO Box 3355
San Ramon, CA 94583

or, copy, fill in and e-mail to: fredklink@comcast.net

You will be placed on our mailing list for upcoming events.

Name:	______________________________________________________
Address:	______________________________________________________
Phone:	______________________________________________________
Email:	______________________________________________________
I am, or was in the past, a member of these mounted reenactment organizations:
________________________________________________________________

I own or have access to a horse which I can transport to events:

o

Yes

o

No

My level of riding experience is:

o Never ridden

o Beginner

o Intermediate

o Advanced

Do you own any 1941 period cavalry uniforms or equipment? o Yes o No

If "yes", briefly explain: ________________________________________

Do you have any physical conditions which may limit your ability to participate in strenuous activity?

o Yes o No

If "yes", briefly explain: ________________________________________

Have you been, or are you now, prohibited from the possession of firearms by any government agency?

o Yes o No

If "yes", briefly explain: ________________________________________ __________________________________________________________