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