Application for Membership...

                                                             (You must complete the form before printing it.*)

Check applicable box:  New, Term   New, Life     Renewal     Life     Reinstated

Name:

Last: First:   MI:       

Last Name in Service:   E-mail:

Home Address:

Street:    P.O. Box:   Apt. #

City: State:    9-digit ZIP Code: 

SSN:    Telephone:  ()   DOB (Mo/Day/Yr):

Chapter Code (i.e., IN-1): Service Dates (Mo/Yr):  from to

Next of Kin:

Name:    Relationship:

Address:

Street:    P. O. Box:    Apt. #

City:   State:    9-digit ZIP Code: 

Type of Membership (check one)

                 1 year -- $15                                    30 & Under -- $220    46 - 60  ------- $155

Term                                                Life

               2 year -- $25                                    31 - 45 --------- $190    61 & over --- $120

                                                                                                                       Enclosed Dues: $

How did you hear about WMA? 

"I certify that I am now serving or have served honorably in the

 United States Marine Corps, regular or reserve components."

Signature:    Date: 

MAKE CHECK PAYABLE TO WMA AND MAIL TO:

Women Marines Association

P.O. Box 10128, Moreno Valley, CA  92552

*If you cannot print this page,

please call 1-888-525-1943 and request an application be mailed to you.