Military Society of the War of 1812 - Membership

Membership Regalia

Blazer Patch ~ $40.00 (Item#1)

Large Medal ~35.00 (Item #2)

Small Medal ~ $25.00 (Item #3)

1812 Neck Tie ~ $40.00 (Item #4) or

1812 Bow Tie ~ $40.00 (item #5)

Rosette ~ $15.00 (Item #6)

Order Item (s)

#1____#2____#3____ #4____#5____

+ $10.00Shipping Total $_________

Name:______________________________

Address:____________________________

City, State, Zip: _______________________

Email:______________________________

Tel: ________________________________

Membership Certificate ~ $75.00 + $15.00 Shipping: Total:__________

Name:______________________________

1812 Ancestor: _______________________

Address:____________________________

City, State, Zip: _______________________

Email:______________________________

Tel: ________________________________

Make Check payable: Military Society War 1812

Print and Mail to:

COL Charles Lucas

2039 Palmer Avenue

Larchmont, NY 10538

Military Society of the War of 1812
20 West 44th Street, Suite 506, New York, New York 10036
914-434-3074

Webmaster: Tracy Ashley Crocker