Adult Membership Application Form

H.M.S. Richmond's Ship's Company

(Ages 18 and over)


Complete this application on line and transmit to the Richmond Unit by clicking on the "Submit" button at the bottom of the form. You may also fill out the form on line and then print the form and submit for enhanced security. Post to: Frigate Richmond, 5545 Woodridge St.,Toledo, Ohio 43623. In either case, you must post your dues to this same address before membership can be effected. Make checks payable to H.M.S. Richmond and post to the same address above. Please be advised that your dues pays to insure the historical event sponsor. Due to the increase litigious nature (and inherit danger) in participating in events such as these, insurance is increasingly important.

A fully initialed and signed "Adult General Release of Liability" form must be completed and sent with your dues check. This form must be printed out and manually signed by each individual member, or in the case of a family membership, by each family member. The Admiralty will not allow us the liberty of deviating from this requirement. Forward both your application(s) if not submitted electronically, the General Release of Liability and your dues check to: Frigate Richmond, 5545 Woodridge St.,Toledo, Ohio 43623.

Note: For family memberships, each individual family member must complete this application. This is necessary to ensure a record of each member is recorded. 

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
 Phone
FAX
E-mail

Choose one of the following options:

New Member
Renewal

Choose one of the following options:

Individual Membership $20 (Commissioned Officers $50; Midi, Warrants $35)
Family Membership $30 (Com. Officers $60; Midi, Warrants $45)

Please list family member actually paying the dues:

Name

Choose one of the following options:

Member of the Richmond's Ship's Company crew
Member of the Richmond's Marine Grenadier Detachment

Choose one of the following options:

Military Persona
Civilian Persona

Enter the billet (position) you are requesting in this unit:


Enter any allergies, handicaps or other medical information, which might impact your ability to participate as a Richmond member in the space provided below:

Enter the person to contact in case of emergency in the space provided below.


Enter the contact person's relationship to you in the space provided below.


Enter that person's phone number (include area code) in the space provided below.


List any skills, hobbies, work history, talents or prior reenacting that may benefit the Richmond's ship's company:


Your signature (or type in if electronically submitting) in the space provided below:

I herby acknowledge that I am fully aware of the nature and purpose of the activities of the H.M.S. Richmond, Inc. (Richmond). I understand that these activities are, in addition to being educational and enjoyable, are potentially dangerous, and I voluntarily accept any risks involved. I agree to be bound by the rules and policies of the Richmond's Bylaws and the Captain's Order Book and to obey the direction of the governing officials at Richmond events, so long as my safety or those around me are not jeopardized.


Enter the date signed:

-- mm/dd/yy

All below for Richmond Official Use:

Billet assigned:


Enter the date of assignment:

-- mm/dd/yy

Accepted by appropriate Navy/Marine commander?

Approved

Unit dues cleared bank?

Dues cleared

Enter the date sent to Richmond's Purser :

-- mm/dd/yy

Indicate type of dues received:

Individual $15 (officer; Midi, Warrant $25)
Family $25 (officer; Midi, Warrant $2)

General Release of Liability received signed?

Recorded and filed with the Lords Commissioners of the Admiralty


Repair to the Adult General Release of Liability Page | Repair to the Site Index Page
HMS Richmond Membership Application
Copyright 2005 [HMS Richmond, Inc.] All rights reserved.
Revised: Janruary30, 2005