The Confederate patriot through whom I petition for membership, and who adhered to the Cause of the Confederate States of America, was my:
Relation —Please choose an option—2nd Great Grandfather2nd Great Uncle3rd Great Grandfather3rd Great Uncle4th Great Grandfather4th Great Uncle5th Great Grandfather5th Great Uncle6th Great Grandfather6th Great Uncle7th Great Grandfather7th Great Uncle8th Great GrandfatherCousinFatherGrandfatherGreat GrandfatherGreat UncleUncle
whose name was
Confederate Soldiers Full Name*
of
City/County
State —Please choose an option—AKALARAZCACOCTDCDEFLGAIAIDILINKSKYLAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
My (check one) Lineal Collateral
Confederate Ancestor was a
Rank —Please choose an option—1st Corporal1st Lt.1st Sergeant2nd Corporal2nd Lt.2nd Sergeant3rd SergeantAsst SurgeonBody ServantBrigadier GeneralCaptainChaplainColonelCorporalGeneralLt. ColonelLt. GeneralMajorMajor GeneralPrivateScoutSergeantSgt MajorSurgeon
In Company Company —Please choose an option—ABCDEFGHIJKLMNOP
Regiment
My Confederate Ancestor was:
Paroled
Surrendered
Released On Oath
Discharged
Killed
Died
Died on SoldierDeathDate
SoldierBurialSite
Who are you?
Full Name*
Address*
City*
State* —Please choose an option—AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWY
ZipCode*
Date of Birth*
Occupation
Cell Phone*
Other Phone
Email Address*
Referred By
Camp Name/Number
