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82ND Airborne Division Association Membership Application

(    ) New Member                   (    ) Renewal                     (     )  Reinstatement 

Enclosed is $20.00, my membership dues for the year____________, subscription to the Paraglide included.
New Members must include proof of glider/Airborne qualifications or service with the 82d airborne Division.

   ____LIFETIME MEMBERSHIP ($150.00 FOR 49 YEARS AND UNDER OR $100.00 FOR 50 YEARS + ) $________     

                                               Date Submitted:_____________________ (Prior to 1 January 2011)

  Last Name:_________________________    First: __________________  MI: _____________

   Address: _____________________________________________________________________

   City, State Zip Code + 4: ________________________________________________________

   Rank: _____ASN or SSAN: _________________E-MAIL ADDRESS:____________________

   Airborne Unit(s): _______________________________________________________________

  Dates of Airborne Service: _______________________to ______________________________

 Date of Birth: __________________________Single: __________Married: ________________

  Spouse's Name: ____________________# of children: ____ Phone #: (      ) ________________

        Chapter Preference:  FAYETTEVILLE CHAPTER

Make check payable to:  Treasurer, Fayetteville Chapter, 82nd Abn. Div. Association, Inc.
P.O. Box 40933, Fayetteville, NC 28309-0933

PRINT OUT FORM AND SEND WITH CHECK