Marine's Memorial Association

Benefactor Membership Information

Military Status

Field Is Required Select Gift Amount:

$275.00

Veteran Membership

$325.00

Veteran Membership + 1 Cardholder

$375.00

Veteran Membership + 2 Cardholders

$425.00

Veteran Membership + 3 Cardholders

$4,500.00

Benefactor- Individual Plan (includes spouse)

$5,500.00

Benefactor - Family Plan (includes spouse and adult non-military children)

$150.00

Active Duty/Reserves Membership + 2 Cardholders

$200.00

Active Duty/Reserves Membership + 3 Cardholders

Additional Donation:

Service Branch

Estimated Date You Entered US Military Service

Estimated End of Active Service in US Armed Forces (or Date on CAC)

If you served during any of the War Periods below, please select those dates (choose 1)

What was your last duty assignment/command while serving OR what is your current assignment?

Characterization of Service

Current Rank or Highest Rank Attained

Benefactor Wall Listing

Benefactors are listed on our Benefactor Wall in the Lobby of the Marines' Memorial Club. Please indicate your requested inscription (two lines available), or if you would prefer to not have your name listed on the Wall. The most popular format is: "Mr. Joe Benefactor" for former military and "Colonel Joe Benefactor, USMC (Ret)" for retired. However, you may include your spouse's name, years of service, or other items as long as they fit on the two lines.

Benefactor Wall options (Choose 1)

Benefactor Wall Listing Line 1

Benefactor Wall Listing Line 2

Contact Information

Member First Name:

Member Middle Name:

Member Last Name:

Member Street 1:

Member City:

Member State/Province:

Member ZIP/Postal code:

Email Address:

Member Phone Number:

Birthdate

Referral

Referring Member/Other

Spouse Cardholder

Spouse First Name

Spouse Last Name

Spouse Email

Spouse Relationship

Number of Additional Cardholders?

Additional Cardholder 1

First Name

Last Name

Relationship

I understand that cardholders on my membership must be at least 21 years old.

Yes

Additional Cardholder 2

First Name

Last Name

Relationship

I understand that cardholders on my membership must be at least 21 years old.

Yes

Additional Cardholder 3

First Name

Last Name

Relationship

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:

First Name:

Middle Name:

Last Name:

Suffix:

Street 1:

Street 2:

City:

State/Province:

ZIP/Postal Code:

Country:

Yes, I would like to receive communication from this organization.

Remember Me

Payment Information

Credit Card Information:

Credit Card Type:

Credit Card Number:

Expiration Date:Select month of credit card Select Expiration Year

CVV Number: What is this?

Key Words

Menu

Benefactor Membership Information

Benefactor Wall Listing

Contact Information

Spouse Cardholder

Additional Cardholder 1

Additional Cardholder 2

Additional Cardholder 3

Billing Information

Payment Information

Credit Card Information:

Survey

Marines' Memorial Association