The Independent Rifles and Liberty Guards hosts:
Blakely 150th
March 27th-29th, 2015
An Authentic Living History
Registration fees are non-refundable. Incomplete registrations will not be processed.
Name:____________________________________________________________
Street Address:_____________________________________________________
City:____________________________ State:_____________Zip:_____________
Phone:___________________________Email:____________________________
Age:_________
Please Circle One: Federal Confederate
Company Commander________________________________________________
Medical Conditions:___________________________________________________
Emergency Contact Information_________________________________________
Signature:________________________ Date:______________________________
Please make out all checks and money orders to the name listed on the mailing address:
CONFEDERTE FORMS MAIL TO:
Brian DesRochers
1997 Ostrom Drive
Mobile, AL 36605
FEDERAL FORMS MAIL TO:
Walter Cook
585 State Rd. 50
Webster, Florida 33597
Registration will be $20.00 for Confederate and $15.00 for Federal to be paid via check or money order.
Blakely 150th
March 27th-29th, 2015
An Authentic Living History
Registration fees are non-refundable. Incomplete registrations will not be processed.
Name:____________________________________________________________
Street Address:_____________________________________________________
City:____________________________ State:_____________Zip:_____________
Phone:___________________________Email:____________________________
Age:_________
Please Circle One: Federal Confederate
Company Commander________________________________________________
Medical Conditions:___________________________________________________
Emergency Contact Information_________________________________________
Signature:________________________ Date:______________________________
Please make out all checks and money orders to the name listed on the mailing address:
CONFEDERTE FORMS MAIL TO:
Brian DesRochers
1997 Ostrom Drive
Mobile, AL 36605
FEDERAL FORMS MAIL TO:
Walter Cook
585 State Rd. 50
Webster, Florida 33597
Registration will be $20.00 for Confederate and $15.00 for Federal to be paid via check or money order.