PCBA MEMBERSHIP APPLICATION

 

Name______________________________________________________________

Organization Name if applicable_______________________________________

Mailing address_________________________________________________________

(street or P O Box)

______________________________________________________________________

                  city                                                            state                                           zip

Telephone (H) _______________(W)_______________ (FAX)__________________________

E-mail_______________________________________________________________________

Membership type______$10.00 Individual Per Year ___________$20.00 Family Per year

Would you be willing to serve on a committee _______yes ___________no

Did you have ancestors who fought in the Battle of Parkerís Crossroads? ____yes ______no

If so, please give family relationship, soldierís name, regiment, etc._________________________

_____________________________________________________________________________

Do you have photographs, letters, diary, or other information regarding the Battle of Parkerís

Crossroads? __________yes ___________no

If yes, please list items___________________________________________________________

_____________________________________________________________________________

Can you provide copies for the associationís reference library? ______yes _______no

Comments: (please use backside of sheet if necessary__________________________________

_____________________________________________________________________________

Please make check payable to PCBA  and mail to :

Parkerís Crossroads Battlefield Association
20945 Hwy 22 North
Parkers Crossroads,  TN 38388

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