Volunteer Registration Application

First Name ______________________________ Middle _____________________________

Last Name _________________________________________________________________

Social Security # __________________________ Date of Birth________________________

Address ___________________________________ Suite or Apt # ____________________

City _____________________________ State _______ Zip Code _____________________

E-Mail Address _____________________________________________________________

Phone ____________________________ Cell ____________________________________

# Years at Current Address _______ (if less than 1 year, please list previous address below)

Previous Address ____________________________________________________________

Previous Address City ________________________ State _______ Zip Code ____________

A $50 non-refundable volunteer registration fee is required to cover fees for a security background

check and administrative costs. If you include a photocopy of your Concealed Weapon License and/or

your Military ID card attached to this application, then the $50 registration fee is waived.

Concealed Weapon License #*__________________ Expires__________________________

Can you serve on the border ______________ Preferred State _________________________

Are you interested in a leadership position? (check one) Yes No

Credit Card Billing Information: Card Type _______ Card # __________________________

Expiration Date______________ Security Code (last 3 digits on back of card) ___________

Your Full Name* ___________________________________________________________

Billing Address** ___________________________________________________________

Billing City** __________________________________________ Billing State** ________

Signature_____________________________________________ Date_________________

*as it appears on your credit card

**as it appears on your credit card billing statement

If paying by check, make it payable and mail to:

Minuteman Civil Defense Corps

P O Box 003

Griswold, IA 51535

Visit our site @ www.MinutemanIowa.com