Society of Civil War Surgeons Membership Application/Renewal

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If you live outside of USA, you can put your address here, if needed

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Phone Numbers  - At least one [1] phone number is required

Home
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Work
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Cell
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FAX
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E-mail:
Birthday (mm/dd/yyyy)
Civil War Rank
Unit (If Affiliated)
Civil War Position (check all that pertain to you)
Primary Civil War Medical Interest
If position was other, enter it here

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Membership Information

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