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First Interview by/Date

Second Interview by/Date


Approved by/Date

New Member Registration Sheet

Full Name: ______________________________________________ Age: __________


Street Address: _____________________________________ County: _____________
City: _____________________________________ State:_________ Zip: __________
Mobile #: ________________ can receive texts? Yes__ NO__ Home #: _________________
Email Address: ____________________________ Preferred Method of Contact: __________________
Please List 3 Personal 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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