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Membership Information

Military Officers Association of America
Southern Maine Chapter

Membership Application

(Please note that it may be necessary to print out this document before filling in the information.)
I WISH TO MAKE APPLICATION FOR MEMBERSHIP IN THE SOUTHERN MAINE CHAPTER OF MOAA:

Date:  ______/______/______                  
              (month/day/year)

Name:__________________________________________________________________________________________                                                                       
                         (last)                                                (first)                                 (middle)

Spouse’s Name:  _________________________________________________________________________________                                                                     

Rank: ____________________________      Service:  ________________________________                                

Active Duty/ Retired/ Former Officer/ Widow(er) (please circle/underline one)

Regular/ Reserve/ National Guard (please circle/underline one)

Mailing Address:

________________________________________________________________________________________________
(Street Address or PO Box as appropriate)                                                            

________________________________________________________________________________________________
                        (City/Town)                                      (State)                           (Zip Code)
Telephone number:  ______________________________    Email:  _______________________________________                                                          .

National MOAA Card No. (note 1):  ________________________________________________________________                                                                            .

Birthdate (optional):  ____________________________________________________________                                                       .

I have enclosed a $15 check for my chapter dues (note 2): YES / NO (please circle one)

Special Notes:

    1.  Membership in the Southern Maine Chapter requires that you also be a member of the national organization. 
National membership dues are $31 per year.  If you are not a National MOAA member, we will arrange for a one-year
complimentary membership at no cost to you.

    2.  Membership dues for the Southern Maine Chapter are $15 per year.  Chapter dues are waived for Auxiliary
Members (Surviving Spouses).  Please make checks payable to "MOAA Southern Maine Chapter".  Please return this
form and your check to:

                                                      MOAA Southern Maine Chapter
                                                      C/O Membership Chairman
                                                      PO Box 2145
                                                      South Portland, ME  04116-2145

    3.  For additional information, please call (207) 833-5574 or contact our Membership Chairman, Rob McAleer at:
 mcaleer1@gwi.net .
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