| NAME |
__________________ |
__________________ |
__________________ |
|
Last
|
First
|
MI
|
| ADDRESS |
______________________________________________________ |
| CITY/STATE/ZIP |
______________________________________________________ |
| Spouses First Name |
_________________ |
|
|
|
|
I hereby apply for membership
in the
Civilian Conservation Corps Legacy (CCCL) as follows:
|
| ________ Regular Membership:
Mail this application with annual dues of $20.00 |
| ________ Lifetime Membership:
For members of the C.C.C. 1933-1942 Only - $100.00 |
|
|
CCC History:
Please fill out next section as appropriate.
Include company and camp numbers where possible.
|
| I was an enrollee of the CCC |
_______ |
| A family member was an enrollee of
the CCC. |
_______ |
| Relationship: |
_____________________________________ |
| Date of Birth (optional) |
_____________________________________ |
| CCC camp locations |
_____________________________________ |
|
|
_____________________________________ |
|
|
_____________________________________ |
|
Period Served
|
________________ to ________________ |
|
Type of work performed
|
_____________________________________ |
|
Current or past occupation
(optional)
|
_____________________________________ |
|
Signature
|
_____________________________________ |
| Date |
_____________________________________ |
| Telephone (optional |
_____________________________________ |