| Last Name
First
MI |
| Spouse's Name |
| Address Email |
| City
State
Zip
|
| Home Phone Business Phone |
| Date of Birth
,
|
| Date of Enlistment/Commissioning
,
|
| Date of Discharge/Separation/Retirement
,
|
| Type of Application: New Renewal |
Regular AssociateDual |
| I
hereby apply for membership in the Lewis B. Puller, Jr. Detachment #524, Marine
Corps League, Department of Pennsylvania, Carlisle PA 17013 and enclose $30.00 (New Membership) / $25.00 (Renewal) for one
year's membership, which includes a one (1) year
subscription to the Marine Corps League quarterly magazine. I 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. |