Registration for The Battle of Bethesda - Walkerton, VA 23177 -  2017

 Please fill this form out as completely as possible and list all registrants names on this sheet. 

Return to: Kathy Hare 4731 Glen Tara Dr., Midlothian, VA 23112.  Phone 804-744-6224   Email: PeninsulaArtillery@comcast.net   

1st 5 Confederate Gun $100     1st 5 Union gun $100    1st 5 Confederate Cavalry $100    1st 5 Union Cavalry $100

Registration fee is $12 until October 1st after October 1st registration and walk on's is $15.  Childern age 12 and under are free.

Unit Name: _________________________________            Commander:__________________________________

Contact Person:______________________________            Phone (Day) __________________________________

Mailing Address:_____________________________          Phone (Evening)_______________________________  

City, State, Zip:______________________________            Email:_______________________________________

Check which applies to you:      Union _______Confederate________Galvanize______(yes) _______(no)

_____ Infantry              _____Cavalry              _____# of horses         _____Civilian

_____Artillery  # of Guns & type ____________________________________________________________           

_____ Other, please explain________________________________________________________________

Totals:                  Military #____________@ $________ = $_________

                         Civilian #____________@ $________ = $_________

                         Under 12 #___________ (free but must register)

                          Total amount enclosed $_____________

PLEASE MAKE CHECKS PAYABLE TO: Peninsula Artillery

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