Name in full  
Address  
e-Mail
Phone
Home
Phone
Work
Phone
Mobile
Age
Gender
Spouse Name (if applicable)
Children's Names (if applicable)
Who to contact in case of emergency
Contact Phone Number (not travelling with you)
Weapons License No: (if applicable)
Do you have a First Aid Training Certificate?
Do you have any allergies?
Are you taking any medications?
What are your civil war interests?

Are you restricted from any physical activities?

(Please list)
Specific impression you wish to portray?

Do you have any specific

questions or comments?
++ Please note:   The reason that what may be perceived as 'private and personal' information is only gathered so that at any reenactment the Camp Commander will have your information to hand in the event of a mishap.