| #18 | Alex Lowrie | Viroqua |
| #27 | H.A. Tator | Reedsburg |
| #30 | William Taylor | Peshtigo |
| #32 | John McDermott | Boscobel |
| #50 | George Eggleston | Appleton |
| #75 | William T. Sherman | Platteville |
| #71 | W.H. Bennett | Richland Center |
| #102 | F.A. Marden | Wisconsin Veterans' Home King WI |
National Woman's Relief Corps
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December 8, 2004 - DEG