Adopt A Soldier Application

*YOUR NAME:_____________________________

*ADDRESS:________________________________

*CITY:____________________ *STATE:_________ *ZIP CODE:_______________

PHONE NUMBER:__________________________*EMAIL ADDRESS:_________________________

*SOLDIER'S NAME:_______________________________*COMPANY:___________

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LEVEL OF PARTICIPATION: (CHECK ONE)

LEVEL ONE:____ LEVEL TWO:____ LEVEL THREE:_____ *Shirt Size: ________ (LEVEL 3 ONLY)

AMOUNT ENCLOSED: $_________________

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PLEASE MAIL YOUR CHECK OR MONEY ORDER ALONG WITH THIS FORM TO:
14th Regiment NYSM Company E. Living History Association
7-Oakmont Avenue
Selden, NY 11784