Prospective Member Information Request

Email Address:            

First Name:          

Last Name:          

Address Line 1:           

Address Line 2:    

City:                           

State:                         

Zip/Postal Code:   

Phone:                        

Please provide the name of your Revolutionary ancestor and the state in which he/she served (if known).

NOTE: It is not necessary to submit more than one request if you have multiple ancestors.

Name of Patriot:   

State of Service:   

How did you

learn about DAR:  

If you have a relative who was/is a member of DAR, please provide her information:

Relationship:        None Mother Sister Grandmother Aunt Cousin Other

Relative's Name:  

Relative's DAR

National Number:           (If known)

A Junior Member is a DAR member age 18 through 35 years of age (until her 36th birthday).

Will you be a Junior Member?    No         Yes   

Please tell us about your interests:

(select all that apply)