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UNITED STATES MARINE CORPS HISTORICAL COMPANY
ACTIVE MEMBERSHIP APPLICATION
(All information on this form is confidential, and is intended for USMCHC internal administrative use only)
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Name:........................................................... ......................................... Date of application.:.........................
(Last name) - (First name) (Middle initial)
Home Address:..........................................................................................
(Number and street or rural route)
(City, Town, or Post Office) (State) (Zip code)
Telephone: (H) (..........)............-....................., (W) (.....) ................., E-mail:...........
Date Of Birth:.........../............./.......... SSN (last 4 #):..................... Height:........ft. .in. Weight:..............lbs.
(Month, day, and year)
OCCUPATIONAL QUALIFICATIONS
(Main occupation or skill) (Years experience)
2................................................................ .........................
(Other occupation or skill) (Years experience) MILITARY SERVICE
(If none, indicate so under Branch)
Branch:..................................................................... from.........../............./....... to.........../............./..........
(USMC, Army, Navy, Air Force, Coast Guard, NG) (Month, day, and year) (Month, day, and year or present)
Highest (or current) rank:................................. Current status:..................................................................
(Active, Reserve, Ntl. Guard, Retired, prior service)
PHYSICAL CONDITION
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(List any relevant disabilities, restrictions, allergies, medications, etc.)
AREA(S) OF INTEREST
• What period(s) in Marine Corps history are you interested in presenting / researching?
Colonial period.........., War of 1812 era..........., Mexican War era.........., Civil War era.........., Span-Am War era...........
WWI era............, Banana Wars.........., WW2 / Korean era..........., Vietnam War era..........., Post Vietnam era..........,
• I am interested in functioning as a "Living History" interpreter...........(initial entry will be as a WW2 era interpreter.
Expansion into other periods will be allowed upon successful completion of probation. If you have a specific area of interest other then the WW2 era, you may contact the HC Directors office to discuss entry into one of our "specialty detachments")
• I am interested in functioning as a modern contemporary interpreter / researcher.........; My area(s) of interest are:
Research and writing........., Lectures and exhibits........... Tour guide / announcer.........., Program development..........
• Service (Living History Interpreters): U.S. MARINE CORPS (infantry)....... U.S.M.C. WOMEN'S RESERVE.......
ADDITIONAL INFORMATION
You must include a brief resume describing your background, experience (if any) in historical interpretation, pertinent educational background, reason's for wishing to join, and areas of interest. Please enclose a recent photograph if possible.
Name of Sponsoring Member (If applicable):......................................................................................................................
Return to: USMCHC Public Affairs
Attn: Director's Office
3807 Baker Valley Road
Frederick, Md. 21704-7652
Questions? call Gy.Sgt. Williams (301) 662-3141 (day or eve), or your Regional representative.
N.M.C.-SS-l-A&I HC 2/00 Revised 11/03
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