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






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