Name:
Spouse (if applicable):
Civilian Email:
Home Phone:
Mobile Phone:
Home of Record:
Date of Birth:
Rank:
Last four digits of SSN:
Desired Membership:
$35 - Veteran Annual
$350 - Veteran All-American
$8.20 - Military Annual
$82 - Military All-American (Junior Enlisted)
$150 - Military All-American (Enlisted / Junior Officer)
$350 - Military All-American (Senior)
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