WMA MI-2 Chapter MEMBERSHIP APPLICATION
It's easy to join. Fill in all of the blanks, print and mail!
Name:
Last: First: MI:
Last Name in Service: E-mail:
Home Address:
Street: P.O. Box:
Apt. #
City: State: ZIP Code:
Snowbird Address: Start/stop dates to
Street: P.O. Box:
Apt. #
City: State: ZIP Code:
Telephone: () DOB (Mo/Day/Yr):
Chapter Code MI-2 Service Dates (Mo/Yr): from to
Next of Kin:
Name: Relationship:
Address:
Street: P. O. Box: Apt. #
City: State: ZIP Code: Phone
Type of Membership (check one)
Term 2 year -- $20
Enclosed Dues: $
You MUST be a member of WMA National to join at the chapter level.