First Name        

Last Name        

Home Address        

City        

State (2 Letters)        

Postal Code        

 Home Phone w/Area Code         no spaces or dashes

Cell Phone    no spaces or dashes

Fax Number  no spaces or dashes

Email Address        

Special Notes/ Skills /Re-enacting Experience

If you are connected with an existing unit that wishes to become associated with the ERA please check here  

Name of Unit 

Contact Person    Email Address