Personal Information
Member ID
*First Name
First Name is required.
Middle Name
*Last Name
Last Name is required.
*Rank
Select...
N/A
1LT
2LT
A1C
AB
Amn
Brig Gen
Civilian
CMSgt
CPO
CW01
CW02
CW03
CW04
Captain
Colonel
General
Lt Col
Lt Gen
MSgt
Maj
Maj Gen
Mr
Mrs
Ms
SMSgt
SSgt
Sgt
SrA
TSgt
Required
*Military Component
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N/A
Active Duty
Guard
Reserve
Required
*Uniformed Services
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N/A
USAF
USA
USN
USMC
USCG
USSF
NOAA
USPHS
Required
*Military Status
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N/A
Active
Veteran
Retired
Required
*War Veteran
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Yes
No
War Veteran is required.
*War Period
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N/A
World War I: 04/06/1917 - 11/11/1918
World War II: 12/07/1941 - 12/31/1946
Korean Conflict: 06/27/1950 - 01/31/1955
Vietnam Era: 02/28/1961 - 05/07/1975
Persian Gulf War: 08/1990 - 09/2001
Global War on Terrorism: 09/2001 - present
War Period is required.
Recuiter/Retainer ID
Recuiter/Retainer Chapter #
*Address
Address is required.
*City
City is required.
*State
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Armed Forces Am.
Armed Forces Europe
Alaska
Alabama
Alberta
Armed Forces Pacific
Arkansas
American Samoa
Australia
Arizona
Bermuda
Brazil
British Columbia
California
Canada
Colorado
Connecticut
Canal Zone
District of Columbia
Delaware
Denmark
El Salvador
England
Florida
France
Georgia
Germany
Greece
Guam
Hawaii
Holland
Iowa
Idaho
Illinois
Indiana
Ireland
Israel
Italy
Japan
Korea
Kansas
Kentucky
Louisiana
Massachusetts
Manitoba
Maryland
Maine
Mexico
Michigan
Minnesota
Missouri
Mariana Islands
Mississippi
Montana
New Brunswick
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Foundland
New Mexico
Nova Scotia
Northwest Territories
Nunavut
Nevada
New York
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Philippines
Puerto Rico
Quebec
Rhode Island
South Carolina
Scotland
South Dakota
Saskatchewan
Spain
Sweden
Taiwan
Thailand
Tennessee
Texas
United Kingdom
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Yukon
State is required.
*Zip Code
Zip Code is required.
*Date of Birth
Date of Birth is required.
*Personal Email
Email Address is required.
Email Address is not valid
*Phone Number
Phone Number is required.
Spouses Name
*Number of Dependents
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0
1
2
3
4
5
6
7
8
9
10
Number of Dependents is required.
*Membership Type
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Uniformed
Family Member
Associate
Membership Type is required.
*Membership Term
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40 yrs and Under ($650)
41yrs thru 50yrs ($550)
51 yrs thru 60 yrs($450)
61 yrs and Over ($350)
Membership Term is required.
Remarks
Billing Information
*Credit Card Number
Credit Card Number is required.
*Name on Card
Name on Card is required.
*Expiration Date
Expiration Date is required.
*Security Code
Visa/MC/Disc enter '0xxx' AMEX enter 'xxxx'
Security Code is required.
Billing address same as personal address
*Billing Address
Billing Address is required.
*Billing City
Billing City is required.
*Billing State
Select...
Armed Forces Am.
Armed Forces Europe
Alaska
Alabama
Alberta
Armed Forces Pacific
Arkansas
American Samoa
Australia
Arizona
Bermuda
Brazil
British Columbia
California
Canada
Colorado
Connecticut
Canal Zone
District of Columbia
Delaware
Denmark
El Salvador
England
Florida
France
Georgia
Germany
Greece
Guam
Hawaii
Holland
Iowa
Idaho
Illinois
Indiana
Ireland
Israel
Italy
Japan
Korea
Kansas
Kentucky
Louisiana
Massachusetts
Manitoba
Maryland
Maine
Mexico
Michigan
Minnesota
Missouri
Mariana Islands
Mississippi
Montana
New Brunswick
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Foundland
New Mexico
Nova Scotia
Northwest Territories
Nunavut
Nevada
New York
Ohio
Oklahoma
Ontario
Oregon
Pennsylvania
Prince Edward Island
Philippines
Puerto Rico
Quebec
Rhode Island
South Carolina
Scotland
South Dakota
Saskatchewan
Spain
Sweden
Taiwan
Thailand
Tennessee
Texas
United Kingdom
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Yukon
Billing State is required.
*Billing Zip Code
Billing Zip Code is required.
Electronic Signature
Type your name to electronically sign the form.
*Signature
Signature is required.