Printable S&DUSCT
membership form
Rep. Richard Gephardt after signing on as a memorial member of the 1st S&DUSCT, D.C. Chapter with Commander in Chief Asa Gordon, Sec. Gen. S&DUSCT. 
  Rep. Gephardt was requested to adopt Colonel John Holman of the 1st Inf. USCT.
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S&DUSCT MEMBERSHIP FORM

Date:___________________

Name:___________________________________________

Street Address:_______________________________________________________________________

City: _____________________________________________ State: __________ Zip: _______________

SDUSCT Chapter (if known) ________________________________________________ 

Current Membership No.(if renewal) [________]  E-Mail: ___________________________________  Phone:______________________
 
Individual
Annual Membership ............................$25 [    ]
Youth(<20) .........................................$15 [    ]
Lifetime Membership ..........................$100 [    ]
Gold Life ............................................$500 [    ]
S&DUSCT Chapters*

Annual Registration ............................... $50 [    ]
Lifetime Registration ............................ $250 [    ]
* A S&DUSCT Chapter is charted by the African American Civil War Memorial Freedom Foundation with 15 or more members of the S&DUSCT.

Memorial Member .......... [    ]
Name of adopted USCT soldier __________________________________
Please assign me an adopted soldier ..... [    ]

Descendant Member ..........  [    ]

Name of soldier listed on Wall of Honor ________________________________________

Regiment in which soldier served ______________________________________________
 

MAILING Info.
Please make checks payable to:
African-American Civil War Memorial
 Thank you for your support.

SDUSCT Membership Department
African-American Civil War Memorial
P.O. Box 73517
Washington, D.C. 20009