On-Line Download Mail-In Form - Post 1000

CA Membership Application - Mail completed application to:

Please print and complete the appropriate entries:

First Name: _______________________   Middle  Initial: ___   Last  Name: ________________________

Mailing  Address: ____________________________________________________________________

City:  ________________________________ State: __________ Zip:  _______________

Home Phone: (_________)______________________________

My annual dues of $35.00 are paid by:
        Personal Check     Money Order     Cashiers Check
 
           Visa   Mastercard    Expiration Date: _____________________
      
           Card Number: __________________________________________
 
           Charge Amount: $35.00

Eligibility Dates:
   August 2, 1990 - Open Persian Gulf War
   Dec. 20, 1989 - Jan. 31, 1990 Panama
   Aug. 24, 1982 - Jul. 31, 1984 Grenada/Lebanon
   Feb. 28, 1961 - May 7, 1975 Vietnam War
   June 25, 1950 - Jan. 31, 1955 Korean War
   Dec. 7, 1941 - Dec. 31, 1946 World War II
   Apr. 6, 1917 - Nov. 11, 1918 World War I

Branch Of Service:
   U.S.Army
   U.S.Navy
   U.S.Air Force
   U.S.Marines
   U.S.Coast Guard

 I certify that I  have served at least one day of active military duty during  the
     date(s) marked above and was honorably discharged or still  serving honorably.

 
Signature of Applicant___________________________________   Date:_____________