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To be filled out by SCM Officer Only

Date:___/___/___
Interviewed by:_______________________________
2nd Interview by:______________________________
Recommendation:_____________________________
____________________________________________
____________________________________________
____________________________________________

SCM New Member Registration Form


Full Name:________________________________________Gender:( M or F) Age:________
Street Address:____________________________________________ County:____________
City:_______________________________________________State:_______Zip:__________
Home #:____________________Mobile#:__________________Can you receive texts?_________
Email:____________________________________Prefered method of contact_______________________
Please List Three Persoval References
Name:____________________________________________Phone#:____________________
Name:____________________________________________Phone#:____________________
Name:____________________________________________Phone#:____________________
Please state below in your own words, Why you want to become a member of the Stokes County Militia

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