Early Arkansaw Reenactors Association     

                         Membership Form



   Please print this form, fill it out, and mail it and a check for single ($12) 
	 or household ($15) to:

                          EARA
                          P.O. Box 21491
                          Little Rock, AR 7221-1491

            (Please write legibly -- we want to get it right!)




First Name: ________________   Camp Name: ________________   Last Name: ____________________  

Spouse Name: _______________   Camp Name: ________________   Last Name: ____________________

Children's Names (and ages): _______________________________________________________________

____________________________________________________________________________________________



Mailing Address:

Name (if different than above):______________________________________________

Street: _____________________________________________________

City:  ______________________________  State: ______   ZIP: _________________





Home Phone (including area code): _________________

Work Phone (including area code): _________________

FAX:  _________________

Cell Phone:  _________________

email #1: _________________________________________________

email #2: _________________________________________________
					
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