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The 506th Airborne
Infantry Regiment Association (Airmobile - Air Assault)
2013 Associate
Membership Dues Form
Download Membership Application [pdf]
Membership: Annual $25.00 [ ] OR 5 Years $115.00
[ ] for The Currahee!
newsletter AND
Select [X] one of the following:
[
] 506th Era that your relative served/Company Roster OR
[
] Roster of all Eras of the Regiment [available
ONLY to those with eMail addresses]
Additional postage
to address outside US:
$ 5.00 [ ]
Optional Donation for Expenses: $___________
TOTAL AMOUNT ENCLOSED: $___________
Last Name: _____________________
First Name: _________________ M.I. ____
Street Address /PO Box:
_______________________________________________
City: ____________________________
State: _______ Zip Code: _____________
eMail Address: _______________________________________________________
Phone Numbers (Please include area code):
Home: _________________________
2nd Phone: __________________________
Did either you or your
spouse serve in the U.S. Military?
If yes, please include
the following:
Branch of Service: _____________ Unit: __________________________________
Dates of Service: ______________________________________________________
Did you have a relative
who served with the 506th Infantry?
If yes, please include
the following:
Veteran's Name: _____________________________________________________
Relationship: ________________________________________________________
Company: __________ REGT/BN/BG: ____________________
Rank:_________
Dates of Service with the 506th Infantry: _________________________________
Other connection to
the 506th Infantry?
_________________________________
Payment Options (choose one below) |
Check Enclosed - Check Number |
AMEX |
Visa |
MasterCard |
Discover |
|
Card Number |
|
CVC Number (Code on back of card) |
Expiration Date |
Card Billing Addres |
Card City, State, Zip |
Name on Card |
Signature |
TOTAL AMOUNT ENCLOSED |
$ |
Select [X] one or more of the following
options if they apply:
Change [ ] Add [ ]: Name [ ]
Mailing Address [ ] Phone number(s) [ ] eMail [ ] Other [ ]
[ ] I request my contact information not be listed in either
the 506th Association Roster or the Currahee
eMailRoom, nor that it be given to anyone other than an Association
Officer without my express consent.
Payment can be made by credit card or make your check or
money order payable to:
The 506th Airborne Infantry Regiment Association
Mail this Membership Dues/Donation Form and your payment to:
The 506th Airborne Infantry Regiment Association (Airmobile - Air Assault)
Attn: Membership, 950 Glenn Drive, Suite 150, Folsom, CA 95630
(855) 506-0506 | 506thmembership@506infantry.org
These pages are maintained the
506th Airborne Infantry Regiment Association (Airmobile - Air
Assault)
This page updated
11/26/2013
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