(Name) ________________________________________________(Phone)______________

(Mailing Address) _________________________________________(Date)_______________

(City) ______________________ (State)_____ (Zip) ________ (Post #) 1977 (Dues) $20.00

Please check appropriate eligibility dates and branch of service below.
 

O Aug. 2, 1990 - OPEN - to cessation of  hostilities as determined by U.S. Government	O U.S. Army
O Dec. 20, 1989 - Jan. 31, 1990	O U.S. Navy
O Aug. 24, 1982 - July 31, 1984	O U.S. Air Force
O Feb. 28, 1961 - May 7, 1975	O U.S. Marines
O June 25, 1950 - Jan. 31, 1955	O U.S. Coast Guard
O Dec. 7, 1941 - Dec. 31, 1946
O April 6, 1917 - Nov. 11, 1918
O U.S. Merchant Marine - Dec. 7, 1941 - Aug. 16, 1945

I certify that I served at least one day of active military duty during the dates marked above and was honorably discharged or am still serving honorably.

(Signature of applicant) ___________________________________

(Name of recruiter) ______________________________________