I WISH TO MAKE APPLICATION FOR MEMBERSHIP IN THE SOUTHERN MAINE CHAPTER OF MOAA:
(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)
(Street Address or PO Box as appropriate)
(City/Town) (State) (Zip Code)
Telephone number: ______________________________ Email: _______________________________________ .
National MOAA Card No. (note 1): ________________________________________________________________ .
Birthdate (optional): ____________________________________________________________ .
Chapter dues are $20 per year, but new members DO NOT have to pay dues the first year. Chapter dues are waived for Auxiliary
Members (Surviving Spouses).
1. Membership in the Southern Maine Chapter requires that you also be a member of the national organization.
National membership dues are $40 per year for Premium Membership. There are also options for Lifetime Membership
and Free Basic Membership. Additional information can be found at the following link: http://www.moaa.org/join/
2. Submit Membership Application information via email: Click Here or return this form 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: