*Last Name
__________________ First Name
_________________ Middle Initial
_____*Service (Circle One): USA
USN USAF USMC USCG USPHS NOAA
*Status (Circle One): Active Duty
Inactive/Reserve Retired
*Highest Rank_______________Retired
at Rank (Circle One): YES NO
*Street Address:
___________________________Congressional
Dist._________________
*City: ____________________________
State: __________ Zip:
__________ - _________
*Home Phone: ____-_____-________
Email:
__________________________________
Date of Birth: __________________
SSN: ______-_____-_________
*Service Dates: From ___________
To: ______________
* War Veteran Status (Circle All
That Apply): WWII-Africa,
WWII-Europe, WWII-Asia, Korea, Gulf-SW Asia,
Vietnam, Iraq/Afghanistan, (GWOT)
Other _______________
*Spouses Name:
__________________________ Spouses Date
of Birth: ____________
Additional Spouse Interests:
__________________________________________________
*MOAA (Formerly TROA) Member
(Circle One) YES NO If YES, MOAA
Number
(2nd Line on A Military Officer Magazine
Mailing Label): ________________________
Is Applicant "Life Member" of MOAA?
(Circle One) YES NO
If employed, current position:
______________________________ (If
available, please attach a copy of your
business card to the application)
Employer Name:
___________________________City/State:________________/_______
SIGNATURE:
___________________________________
DATE:_____________________
Mail Application to:
VP- Membership MOAA-GDC
P.O. Box 7692 Inwood Station
Dallas, TX 75209-0692.
Your 2008 MOAA-GDC
Membership is free. Annual dues are due 1
November 2008.
* Required