Fort Larned Old Guard
Membership Application

___________________________________________________________________________
Name[s]

___________________________________________________________________________
Address

___________________________________________________________________________
City, State, Zip Code

___________________________________________________________________________
Telephone

___________________________________________________________________________
E-Mail Address

Is This a New Membership ____ Renewal ____ Gift Membership for Someone ____
Membership Categories [check one]
Private - Individual - $15 to $24 ____ Corporal - Basic Family - $25 to $49 ___
Sergeant - Contributing Individual/Family - $50 to $74 _____
Lieutenant - Contributing Individual/Family - $75 to $99 ____
Captain - Contributing Individual/Family - $100 tp $149 ____
Camp Follower - Non-Profit Organization - $30 and Above ____
Sutler - Business - Partner - $40 and Above _____
Career Officer - Life Membership - $300 and Above ____

All Memberships expire on December 31
Please print this out
Make checks payable to Fort Larned Old Guard and send to:
Linda Peters
1035 S. Bridge St.
Lakin, Kansas - 67860




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