WOMEN MARINES ASSOCIATION
NC-1 TARHEEL CHAPTER
Membership Application
Last Name: ________________________First Name: __________________MI:______________
Last Name in Service: ______________________ SSN:__________________________________
Street Address: ______________________________ PO Box: ___________Apt. #: __________
City: ___________________________ State: ______________ Zip Code: _________________
Home Telephone #: ________________ Cell Telephone #: _______________________________
Email Address: ____________________________________ Retired: circle Yes or No
Service Dates: From ___________ To ______________ MOS: ________________________________
Name of Next of Kin: ______________________________ Relationship: ____________________
Street Address: ____________________________ PO Box: _________ Apt.#. _______________
City: ________________ State: ___________ Zip Code: _________ Phone #: ______________
I Certify that by my signature that I am now serving or have served honorably in the United States Marine Corps regular or reserve components.
Signature _____________________________________ Date: ___________________________
Dues are as follows: National Membership is required for local membership. National Website can be found at http://www.womenmarines.org . Local chapter dues are $5.00 per year or $25.00 to be a Life Member.
Make check payable to NC-1, Tarheel Chapter, WMA and mail with application to:
NC-1, Tarheel Chapter, WMA
Naomi Malone
218 Sunset Drive
Jacksonville, NC 28546
