Please print or type and provide all information requested
Application date_________
Name and Rank______________________________
Date of birth____________
Active Duty____ Retired____ Reserve____ Former____ Associate____
Mailing Address:______________________________
City and State _______________________________
Nine-digit Zip Code _____________
Home Telephone (_____)__________________
Spouse's Name ________________________
I Served in:______________ Company/Battery
__________Battalion ______Regiment
From______ to_______
How did you hear about the Association/Sponsor __________
Referred by Sgt. Grit: http://www.grunt.com__________
Social Security Number __________________
Signature ___________________________
My check for $__________ is enclosed for:
Annual Regular Dues ($20.00) ___
Annual Associate Dues ($20.00)___
Active Duty Dues ($7.50) ___
*Paid in Full Life Member Dues ___
Installment Payment Life Membership ($40.00 installments)___
* Life membership: Under age 55 = $200 / Age 55-64 = $150
Over age 65 = $75
Mail with payment to:
Third Marine Division Association
P.O. Box 297
Dumfries, VA 22026-0297
Please allow 3-5 weeks for processing and receipt of new membership materials.
Thank You and Semper Fidelis