Volunteer Enlistment Form - Co. A/ Colored Ladies
54th Massachusetts Glory Brigade
Name
________________________________________________________________
(First)(M.I.) (Last)
of
____________________________________________________________________
(Street Address)
Town
of__________________________State
of ___________________________
(including
Zip)
aged _______ years,and by occupation a _____________________________________________
does hereby agree to serve as a re-enactor in Company
A of the 54th Regiment, Massachusetts Volunteer Infantry for a period of
1 year, unless sooner discharged by proper authority.
does hereby agree to serve as a re-enactor in the
Colored Ladies’ Christian Relief Association for a period of 1 year, unless
sooner discharged by proper authority.
Sworn and subscribed to this
day of __________________ , 19______
before _____________________________________________________________________
ClerkVolunteer's
Signature
I certify, on honor, that I have carefully examined
the above-named Volunteer agreeably to the Regulations, and that, in my
opinion, he/she is free from all defects and infirmities which would in
any way dis-qualify him/her from performing the duties of a re-enactor,
that he/she was entirely Sober when enlisted; and that he/she is of Lawful
Age
This re-enactor has ____ eyes, ______ hair, is ___
feet, ___ inches high
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Additional
Information
Home Telephone ____________________Work
Telephone_______________________
E-mail address __________________________
Date of Birth __________________Social
Security No. ____________________
Parent/Partner/Spouses’ Name and Phone __________________________________________
Special talents or skills ________________________________________________________
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Company Use Only: Date first Dues Paid _______________Company
No. __________