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Telephone ___________________
Email ___________________________________
New Members MUST complete ALL parts of the application
(Please Print)
1SG Leonard A Funk Chapter 82nd Airborne Division
Association, Inc. Membership Application
__Renewal
__Reinstatement __
New
Member
__Life
Membership
__Enclosed
is $15.00, my dues for the year 20___, including Paraglide
subscription, or
__Enclosed is $16.00, dues for
20___, Paraglide, plus $1.00 for the Educational Fund, or
__Enclosed is $_____ for Life
Membership ($150 if under 50 years of age, $100 if over 50 years of
age DOB:__/__/_____)
Name_____________________________________________Street/RFD________________________________________________
City____________________________________________________State_____ZIP
Code_________________
Rank_________ASN/SSAN__________________Dates of service with 82nd
or Airborne service from____________to___________
Abn/82nd units (be
complete)___________________________________________________________________________________
Present occupation____________________single___married___spouse's
name__________________________# of children______
Chapter Preference________________________
Make check payable to 82nd Abn Div Assoc and mail to Tom
Jensen, 3335 Altherton Dr, Bethel Park Pa 15102-1113 |
