Registration for
BATTLES OF BENTON COUNTY
Re-enactment
October 22 - 23, 2005
Bentonville, Arkansas
Pre-Registration Requested

To allow us to plan a very successful event for you, the reenactors, and the public,
we are asking that you pre-register by October 1, 2005. 

Registration is $5.00 per re-enactor. 
Unit Registration is encouraged.
Walk-ons will be accepted.
Participants under 18 years of age allowed with parental permission and signed waiver

To register, please print and complete the form below. 

You may either:
1) Mail it with check or Visa/Mastercard info to
Battles of Benton County Committee
c/o The Peel House Foundation, 
400 S. Walton, Bentonville, AR 72712
(Make checks out to "The Peel House Foundation")
or
2) Fax it to us at 479-273-9688 with Visa/Mastercard information.

Questions? E-mail: The Peel House Foundation
There will be no civilians camping in the artillery, infantry, or cavalry camps.

Battles of Benton County Registration
Last Name _______________________
First Name
 _______________________
Middle Name
 _______________________
Home Address
 _______________________
City
 _______________________
State
 _______________________
Zip Code
 _______________________
Phone Number
 _______________________
E-mail Address
 _______________________
Group
 _______________________
Army
 __Union     __Confederate
Branch
 __Infantry  __Cavalry __Artillery
Commanding Officer
 _______________________
Identity
 _______________________
Civilian
 _______________________
MCWRA
 __Yes     __No
Company Roster
(Please put names in
the following format:
Doe, John)

Add more as needed.

__________________________
__________________________
__________________________
__________________________
__________________________

If paying with Visa/Mastercard, Card Number ____________________________ Exp. Date _____

Modified 7-11-05