Application for a
c/o K. Steven Monk
P.O. Box 53
Tate, Georgia 30177
EMAIL: [email protected]

Please print and complete this form and send it along with your check, cash or money order in the amount of $15.00 to the address shown above. Checks and money orders should be made payable to K. Steven Monk. A Certificate authenticating your Confederate Ancestry will be sent by USPS mail to the address you provide below. Your name and ancestor information will then be added to the Confederate Wall of Honor on the Confederate American Pride website. All information you provide is held as confidential and will not be shared with any other organization or individual.


By the blood that flows through my veins, I do solemnly affirm that I am a descendant of the Confederate veteran named below. I do further attest that this ancestor served honorably in the service of the Confederate States of America during the War for Southern Independence. Furthermore, in recognition of the sacrifice that he made, I do solemnly avow to defend the legacy he left, the Christian values that he held dear and the principles of Constitutional government for which he fought, from all who would dare assail those righteous principles, so help me God.

Name of applicant (print)

Signature of applicant

Witness (print name)

Signature of witness

APPLICANT’S FULL NAME:_________________________________________________________

STREET ADDRESS:_________________________________________________________________

CITY_________________________________ STATE_________ ZIP CODE:___________________

EMAIL ADDRESS:__________________________________________________________________

PHONE (Optional):__________________________________

THE NAME OF YOUR CONFEDERATE ANCESTOR:_____________________________________

ANCESTOR’S RELATIONSHIP TO YOU:_______________________________________________

THE UNIT HE SERVED IN:___________________________________________________________

MAY WANT TO PROVIDE ABOUT YOUR ANCESTOR:__________________________________


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