Please Print
Check applicacble: ( )New ( )Renewal ( )Reinstated ( )New Life
( ) Life
Date enlisted____________ Date discharged_____________________
How did you hear about WMA?_______________________________
Name___________________________________________________
(Last)
(First)
(M.I.) (Service/Maiden)
Address_________________________________________________
(Street)
(City/State)
(Zip+4)
SSN____________DOB_____________Telephone_______________
(optional) (MO/DAY/YEAR)
Chapter___________________E-mail__________________________
(I.E., TX-2)
Next of Kin_______________________________________________
(Name)
(Relationship)
Address__________________________________________________
(Street)
(City/State)
(Zip+4)
Dues include 'Nouncements and the Membership Directory.
(Check one.) ( ) 1 Year...$15.00 ( ) 2 Years...$25.00
Life (Pro-rated by age): ( ) 30& Under...$220.00 ( ) 31-45...$190.00
( ) 46-60...$155.00 ( ) 61& over...$120.00
Enclosed Dues $________________Enrolled by ____TX-2__________
"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 with application to:
Women Marines Association
P.O. Box 8405
Falls Church, VA 22041-8405
