applicationform

Military Officers Club of Northeast Wisconsin Application

Name, First, M.I., Last

Primary Phone

Work Phone

Date of Birth:

Address, City, State, Zip

Email

Spouse's Name

Birthdate (optional)

Rank

Component

Branch of Service

Military History (complete applicable category)

On Active Duty

Yes No

Entry Date

Former Officer

Yes No

Entry/End Dates

Retired Officer

Yes No

Entry Date/ AD Retirement Date

Are you a member of MOAA? (National Organization)

Yes No

If YES, what is your MOAA number?

If NO, may we join you up for a FREE Basic MOAA Membership?

Yes No

Do you receive Military Officers Magazine?

Yes No

Do you plan to attend regular quarterly meetings?

Yes No

Receiving Military Retired Pay or Survivor Benefits?

Yes No

Would you be willing to serve as a chapter officer or as a member of the Board of Directors?

Yes No Maybe

Note: Chapter dues are $20.00 per calendar year, payable by January 1st each year.

Payment Options

Paid/Paying via Paypal Mailing a check

You can pay dues online via our Membership page or Mail Payment to:
The Military Officers Club of Northeastern Wisconsin, Inc.
N2420 Lakeshore Road
Kewaunee, WI 54216

Comments

After reviewing your application, we will contact you to follow up.

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