2012 Keokuk Civil War Reenactment
Unit Pre-Registration Form

Pre-registration is due by March 31, 2012

Individual Registration will be required at the Registration Booth upon arrival at the event.

If you are with a Unit, the Unit Commander should fill out one form per unit.
If you are not with a unit, please complete this form as an individual pre-registration.



Instructions: 
 

Use the mouse and scroll bar to maneuver around the form. All entries in the form are required. Answer "None" or "0" to entries not applicable. After opening this page, you may disconnect from the Internet and complete the form at your own pace. To submit, simply reconnect before clicking the Submit button at the bottom of the page. However, do NOT close the window or shut off the computer before submitting the form, or you will lose your input and will have to start at the beginning.


Name: 
Street Address: 
City: 
State: 
Zip Code: 
Telephone: 
E-mail Address: 
Unit Name: 
Commander's Name: 
Affiliation (USA, CSA, Civilian): 
# of Infantry: 
# of Artillery: 
# of Artillery Pieces: 
Description of Artillery Pieces: 
# of Cavalry: 
# of Horses: 
# of Medical: 
# of Civilians: 
Total Registering: 

Optional Comments:



When you have completed all entries in the form, click the "Submit" button below. If any entries were omitted, you will receive a page advising you to complete the missing items. Click the "BACK" icon at the very top left of the page in the toolbar, make the corrections, and resubmit.