Anne Arundel County Detachment 1049
MARINE CORPS LEAGUE
APPLICATION FOR
REGULAR MEMBERSHIP
(Please print all entries clearly)
Type of Application - New [__] Renewal [__] Member #:
____________
Name:
_____________________________________________________________
Address:
____________________________________________________________
City:
_______________________ State/Province: ___ Zip/Postal Code:
_________
Your Phone:
____________________________________________
Your E-mail:
____________________________________________
Date of Birth: ____ / ____ /
____
Date of Enlistment/Commissioning: ___ / ___ / ___
Date of
Discharge/Separation/Retirement: ____ / ____/ ____ , Service #:
_________________
I enclose $25.00 for one year's membership. All
memberships include 1-year subscription to:
MARINE CORPS LEAGUE MAGAZINE
I
hereby certify that I have served as a U.S. Marine for more than 90 days, that
the character of my service has been honorable, and if discharged, I am in
receipt of an honorable discharge. By signature on this application, I hereby
agree to provide proof of honorable discharge/service upon request.
________________________________
Applicant's
Signature
________________________________
[Sponsor-where
applicable]
Upon completion, send this form to:
Anne Arundel County Detachment 1049
Marine Corps League
Post
Office Box 804
Severn, Maryland 21144-0804
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