Participant Registration

 

Crossroads of Texas Living History Association

Goliad Massacre – Presidio La Bahia, Goliad Texas

 

March 26-27, 2011

 

Each Combatant must register themselves.

 

Name(s) and Age (s) (if a family, include all ):                                                                                                                           ____________________________________________________

 

Street Address:                                                                                                

 

City:                                         State:              ZIP:                             

 

Phone:                                                 

 

Current Email:                                                                       

 

Home Unit Name or “Individual”:                                            

 

Medical Conditions (include medicinal allergies [i.e.: aspirin, penicillin, lead, etc]:                                                                                                         _____________________________

Adult participant must sign

 

Signature _____________________________Date ____________________