Berks County Patriots

Membership Form

Use this form to join Berks County Patriots
By signing this form, I authonze Berks County Patriots to contact me regarding events, metings, other pertinent group functions. BCP wil keep your contact information confidential and will never release, sell, nor distribute it to anyone other than essential group members.

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Email Address *

First Name *

Last Name *

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Phone Number *

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How did you hear about us? *

What special skills/experience do you have? *

Date Entered