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Search Text
1
Gift & Payment Information
2
Review Gift
Membership Information (Spouse is included at no extra fee)
Military Status
Active
Reserves
Former
Retired
Required
Field Is Required
Select Gift Amount:
$200.00
Veteran Membership
$250.00
Veteran Membership + 1 Cardholder
$300.00
Veteran Membership + 2 Cardholders
$350.00
Veteran Membership + 3 Cardholders
$35.00
Active Duty/Reserves Membership
$85.00
Active Duty/Reserves Membership + 1 Cardholder
$135.00
Active Duty/Reserves Membership + 2 Cardholders
$185.00
Active Duty/Reserves Membership + 3 Cardholders
Membership type:
One Year Membership
Recurring Annual Membership (auto-drafted)
Select a Membership Duration:
Ongoing(Annually)
2 years
Required
Additional Donation:
Military Branch
Marines
Coast Guard
Air Force
Army
Navy
Required
Time of Service
9/11/2001-Present
8/2/1990 - 9/10/2001
8/24/1982 - 7/31/1984
8/5/1964 - 5/7/1975
6/27/1950 - 1/31/1955
12/7/1941 - 12/31/1946
Does Not Apply
Required
Highest Rank
Contact Information
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Member Middle Name:
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Member Street 1:
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FM - Federated States of Micronesia
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PW - Palau
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AE - Armed Forces
AP - Armed Forces Pacific
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None
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Referral
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site presentation
web search
Member/family/friend
other
Required
Referring Member/Other
Spouse Cardholder
Spouse First Name
Spouse Last Name
Spouse Email
Spouse Relationship
Spouse
Required
Number of Additional Cardholders? (Additional Cardholders are $50 each)
0
1
2
3
Required
Additional Cardholder 1
First Name
Last Name
Email
Relationship
Mother
Father
Daughter
Son
Required
I understand that cardholders on my membership must be at least 21 years old.
Yes
Additional Cardholder 2
First Name
Last Name
Email
Relationship
Mother
Father
Daughter
Son
Required
I understand that cardholders on my membership must be at least 21 years old.
Yes
Additional Cardholder 3
First Name
Last Name
Email
Relationship
Mother
Father
Daughter
Son
Required
I understand that cardholders on my membership must be at least 21 years old.
Yes
Billing Information
Specifies to use the donor information as the billing information
Title:
Mr.
Ms.
Mrs.
Miss
Dr.
Required
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Middle Name:
Last Name:
Suffix:
Sr.
Jr.
II
III
IV
V
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AK - Alaska
AL - Alabama
AR - Arkansas
AZ - Arizona
CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
GA - Georgia
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MI - Michigan
MN - Minnesota
MO - Missouri
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VA - Virginia
VT - Vermont
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
AS - American Samoa
FM - Federated States of Micronesia
GU - Guam
MH - Marshall Islands
MP - Northern Mariana Islands
PR - Puerto Rico
PW - Palau
VI - Virgin Islands
AA - Armed Forces Americas
AE - Armed Forces
AP - Armed Forces Pacific
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NL - Newfoundland and Labrador
NS - Nova Scotia
NT - Northwest Territories
NU - Nunavut
ON - Ontario
PE - Prince Edward Island
QC - Quebec
SK - Saskatchewan
YT - Yukon
None
Required
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