485th Tactical Missile Wing
 Alumni Association


Alumnus Life Membership $ 100.00 ($25 per qtr] 
Alumnus 3-year Membership $ 30.00 
Please complete this Application for Membership and mail to:

485th TMW Alumni Association

P O Box 339

South Montrose PA 18843-0339

________________________________________________________________________

APPLICATION FOR MEMBERSHIP


(please print)

LAST NAME:_____________________ FIRST NAME:___________________ MI:____
ADDRESS:______________________________________________________________
CITY:_______________________ STATE:________ ZIP:__________ PLUS:______

Home Phone  (      )                         Work Phone(civ)  (      )

DSN _______________________ Email___________________________________

FLORENNES INFORMATION

UNIT ASSIGNED______________________________ OFF SYMBOL________________

MO/YR ARRIVED_________________________

MO/YR DEPARTED_________________

IN ORDER TO MAINTAIN OUR STATUS AS A VETERANS ORGANIZATION PLEASE COMPLETE THE FOLLOWING:

(INCLUSIVE DATES)

DATE ENT. ACTIVE DUTY (MM/DD/YY) ____________________

DATE DISCH/RETIRED (MM/DD/YY) ____________________

[ ] Yes, I want to be a member of the Association
           [ ] No, I am unable to join at this time but keep my name
on the mailing list.
[ ] Enclosed is a donation to the Association........
Amount enclosed:______________

PLEASE MAKE CHECKS PAYABLE TO: 485th TMW Alumni Association