New Membership Application

MILITARY VETERANS CHAPTER, FMCA

MEMBERSHIP APPLICATION

New ($15.00)_____ Renew ($10.00_____ Reinstate($10.00)_____

Amount Paid $_______Cash______ Check #________  Date__________

Referred by:___________________________________#F____________

Make check payable to: Military Veterans Chapter, FMCA

Or use PayPal to pay your dues safely and securely using a bank account or credit or debit card:

RENEW MVC Dues

1 Yr. Renewal $10.00 USD 2 Yr Renewal $20.00 USD New Member (1 Yr Dues) $15.00 USD New Member (2 yrs Dues) $25.00 USD

Please mail your check or money order to:
Tom Braum, Treasurer
3916 N. Potsdam Ave. PMB 1550
Sioux Falls, SD 57104

If you used PayPal to pay your dues, please add your email address and indicate PayPal as your method of payment.

PayPal email: _________________________________________

F____________________________________________________________________________________

(FMCA #)        Last Name                        First Name                         MI                                   Spouse

Street Address

City and State                                                                                                               Zip + 4

Phone:                                                         Cell(1)                                         Cell(2):

E-Mail Address (please keep your address current with (us)

I certify by my signature below, that I am on Active Duty with or was Honorably Discharged from the United States or Canadian Armed Forces or National Guard.

(signature) _____________________________________________________________________

MEMBERSHIP DUES YEAR IS January 1^st to December 31^st.

We do not pro-rate dues.

Please include a copy of your FMCA membership card.

Please put your FMCA# on the bottom of your check.

We can only keep one address in our files at a time. If necessary, send us a change

of address when you change your permanent address.