First
Battalion, Fourth Marines Association
|
Membership Application |
Name_______________________________Phone
#(Hm)_______________(Wk)__________________
E-Mail__________________________
Birthdate___________________
Address_____________________________
City______________ State______ Zip Code___________
Rank______
Active/Discharged/Retired (A/D/R)_______ Period of
Service(From)__________(To)___________
Personal
Awards/Decorations:____________________________________
(Purple
Heart, Etc.)
_________________________________________________________
_________________________________________________________
Period
of Service with 1st Battalion, 4th Marines: (From)_______________(To)___________________
Unit(s)
assigned to while with 1st Battalion, 4th Marines: Company_________
Platoon____________
Applying
For Annual______Life______Membership Amount_________
Copy
of DD 214/DD215 or Discharge Enclosed
YES_______ NO_______
How Did You Find Out About The Association? Friends Leatherneck___ VFW___MOPH___
WWW Internet___ MC Gazette___ DAV____ CALTRAP___ VVA___ American Legion___
Other(Please Specify)_______________________
|
Dues Information |
Note: Print this form
out and mail in with your check.
Annual
Member - $20.00
Life
Member: Under 55 - $200.00
55 to 64 - $150.00
65 and over - $75.00
Make
Checks payable to:
1st
Battalion, 4th Marines Association
Urbana, Il. 61801
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Feedback to the Webmaster.
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Size __________
If you do not have any of these documents, send
Application and Membership Committee will contact you.