NSUSD 1812 Member Interest Form
Member Interest Form
1. Choose two letter abbreviation for State where you would like to join. *
e.g. GA for Georgia
2. Email
Your answer
3. First Name *
Your answer
4. Last Name *
Your answer
5. Address 1 *
Your answer
6. Address 2
Your answer
7. City *
Your answer
8. State *
Your answer
9. Zip Code *
Your answer
10. Country / Province
Your answer
11. Telephone number *
Your answer
12. Name of War of 1812 Patriot (if you know it)
Your answer
13.Patriot's State of Service (if you know it)
Your answer
14. Comments
Your answer
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